Neuropsychological impairments, vocational outcomes, and financial costs for individuals with traumatic brain injury receiving state vocational rehabilitation services
B. Johnstone et al., Neuropsychological impairments, vocational outcomes, and financial costs for individuals with traumatic brain injury receiving state vocational rehabilitation services, J HEAD TR R, 14(3), 1999, pp. 220-232
Objective: To determine the relationship among neuropsychological variables
, vocational outcomes, and vocational costs for Missouri Division of Vocati
onal Rehabilitation (MO-DVR) clients with traumatic brain injury (TBI). Des
ign: Clients referred for neuropsychological evaluations were followed unti
l DVR case closure. Subjects were grouped according to the following DVR st
atus at case closure: Successfully Employed, Services Interrupted, and No S
ervices Provided. Spearman correlations with Bonferroni corrections were ca
lculated to determine relationships among variables, and Kruskal-Wallis non
parametric one-way analyses of variance (ANOVAs) were conducted to evaluate
differences in DVR group status in terms of neuropsychological variables a
nd DVR costs. Setting: All evaluations were completed through a Midwestern
university neuropsychology laboratory. Patients: 110 consecutively referred
DVR clients with nonacute TBI referred for neuropsychological evaluation.
Main outcome measures: Absolute level (ie, raw/standard scores) of neuropsy
chological functioning and relative degree of decline in: intelligence (WAI
S-R), memory (WMS-R General and Delayed Memory Indices), attention (WMS-R A
ttention Index), speed of processing (Trails A), and cognitive flexibility
(Trails B); DVR costs at closure. Results: 1) Surprisingly, the Successfull
y Employed group had significantly greater neuropsychological impairments;
2) Greater decline in delayed memory was associated with higher DVR costs (
r = -0.30, P < .05); and 3) More indices of relative decline were significa
ntly correlated with vocational outcomes (5/6) than were indices of absolut
e functioning (3/6). Conclusions: DVR is effective in providing services to
individuals with the most significant neuropsychological deficits; it is i
mportant to consider both absolute level of functioning and relative declin
e in functioning when evaluating TBI.