Neuropsychological impairments, vocational outcomes, and financial costs for individuals with traumatic brain injury receiving state vocational rehabilitation services

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.