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Previous research on vocational rehabilitation after traumatic brain injury (TBI) has suggested that coaching and other services provided following job placement are particularly important for successful work re-entry in this population. Methods of defining and measuring these services are needed to estimate more precisely their effects on vocational outcomes. In this study we developed a measure of the type, amount, and location of post-placement interventions that could be completed by treaters in “real time”. Treatment was measured prospectively for 6 months after job placement for 65 people with moderate to severe TBI treated at 5 TBI Model System centers. Centers were found to differ substantially in the amount and location of treatment provided following job placement; centers providing more intensive treatment and treatment at the workplace also served more severely impaired clients at a longer interval after injury. Within centers, participants’ cognitive speed and emotional distress predicted certain aspects of amount and type of treatment provided. Three-fourths of the sample were still working at the placement job after 6 months. Due to the confounding between case mix and treatment variables, unique effects of treatments on outcomes could not be determined. [ABSTRACT FROM AUTHOR]

Background: There are no standards of care to guide the selection of rehabilitation assessment and treatment procedures for patients with disorders of consciousness. Recently, consensus-based recommendations for management of patients in the vegetative and minimally conscious states have been developed and disseminated in neurology and neurorehabilitation. This is an important first step toward achieving evidence-based guidelines of care. Objective: Using a "Grand Rounds" format, we illustrate the application of consensus-based diagnostic, prognostic, and treatment recommendations in a patient who sustained severe traumatic brain injury with prolonged alteration in consciousness. After discussing the salient features of the case, we summarize the basic tenets of clinical care for this population. [ABSTRACT FROM AUTHOR]