Stability of employment after brain injury: a 7-year follow-up study

Forty-three patients with severe traumatic brain injury (n = 24), cerebrova scular diseases (n = 15), or other acquired brain damage (n = 4) were follo wed-up 7-8 years after neuropsychological rehabilitation including a vocati onal re-entry programme. Current vocational status and work history since r ehabilitation were investigated by means of a structured interview. Before interview, the patients were classified on the basis of medical records int o four groups: (A) patients with minor residual neuropsychological impairme nts, (B) patients with minor impairments but psychopathological symptoms, ( C) patients with persistent neuropsychological impairments showing no psych opathological symptoms, and (D) patients with persistent impairments and ps ychopathological symptoms. For patients in group A, a good, and for those i n group D, a poor long-term employment outcome was predicted, while no pred ictions were made for the intermediate groups. Of the 43 interviewed subjec ts, 16 (37%) reported a stable return to work at pre-morbid level and seven (16%) at a lower level. In eight patients (19%), persisting difficulties i n maintaining work were documented. Twelve subjects (28%) had retired withi n a period of 2 years after work trial. The relationship between patient cl assification and longterm employment outcome was only weak. Four out of 11 patients with a good prognosis (group A) experienced vocational adjustment problems or had retired. Three out of 10 patients with a poor prognosis (gr oup D) were able to continue successfully with their previous jobs. These c ases are described in detail. The employment outcome of the intermediate gr oups was very heterogeneous. The results suggest that particular attention should be paid to the long-term consequences of a reduced capacity for work , even if minor in degree. The success of patients despite a poor prognosis illustrate unsolved problems in relation to the ecological validity of neu ropsychological measures of executive dysfunctions.