Search

The Spirituality and Health Research Project of the MU Center on Religion and the Professions is investigating the relationships that exist among religion, spirituality, and health for persons with heterogeneous medical conditions. Pilot studies indicate that spirituality and congregational support are related to health outcomes, but religious practices are not. Additional research indicates that spiritual experiences are related to diminished right parietal functioning (through meditation/ prayer or brain injury), which is associated with decreased sense of the self. Implications for health professionals are discussed.

Purpose: Missouri's traumatic brain injury (TBI) early referral programme connects individuals with TBI to state services in the acute stages of recovery. This study evaluated the impact of this programme on service utilization and functional outcomes., Method: Sixty-seven individuals in the Early Referral (ER) programme were compared with 31 individuals who received services later in their recovery (controls) in terms of their functioning upon programme enrollment and programme services received. Telephone surveys were then completed with 29 ER and 22 later-referred controls assessing social/emotional and vocational functioning, as well as satisfaction with programme services., Results: The ER group had greater functional limitations than controls upon enrollment. Despite this, at follow-up the ER group evidenced significantly better social integration, emotional well-being and vocational functioning than the control group. Individuals in the ER group did not require/receive more programme resources to achieve these better outcomes. Across both groups, 91% reported feeling the programme is valuable for individuals with TBI., Conclusions: Missouri's TBI early referral programme provides efficacious and cost-effective targeted support for individuals with TBI. Contact with clients and their families during or shortly after acute rehabilitation appears to be associated with better functional outcomes without an increase in the level of services rendered.

Objective: To evaluate differences in outcome in persons with violent versus nonviolent traumatic brain injury (TBI) etiology., Design: Two-group (violent vs nonviolent) 1-year follow-up study., Setting: Midwestern medical center TBI Model System serving a predominantly rural catchment area., Participants: Forty-five (n = 19 violent TBI etiology; n = 26 nonviolent TBI etiology) inpatients with primary diagnosis of TBI followed up as outpatients 1 year after injury., Main Outcome Measures: Substance use, income source, employment status, Wechsler Adult Intelligence Scale--Revised (abbreviated version), Logical Memory I and II from the Wechsler Memory Scale--Revised, Wide Range Achievement Test--Third Edition Reading subtest, Trail-Making Tests A and B, Rey Auditory Verbal Learning Test, Community Integration Questionnaire, Neurobehavioral Functioning Inventory., Results: Members of the violent group were more likely to be men, of a racial minority, unemployed, and have low income. Substance abuse was common among both groups prior to injury, with significant declines at 1 year. Follow-up also revealed significant group differences in verbal intelligence, social integration, productivity, and source of income, but nonsignificant difference in employment. In all comparisons, more favorable outcomes were found for the nonviolent group., Conclusions: Persons with violent injury etiology have poorer premorbid functioning and are likely to have less favorable outcomes than the general population with TBI. Therefore, persons with violent TBI etiology may require more intensive aftercare programming to promote improved rehabilitation outcomes.

Although there is considerable research on the vocational outcomes of individuals with traumatic brain injuries (TBI), there has been minimal research on the characteristics of persons with TBI who seek services from state vocational rehabilitation services. Such research is deemed critical given the significant number of individuals who request such services, as well as the significant federal and state costs associated with these programs. The current article reviews a series of studies completed collaboratively between the University of Missouri-Columbia and Missouri Division of Vocational Rehabilitation (DVR). Information is reported regarding the typical demographic, injury severity, and neuropsychological characteristics of DVR clients with TBI, as well as the most common DVR services provided to them and their vocational outcomes (i.e., successful, unsuccessful). Studies are reviewed which indicate that the provision of specific DVR services predict successful vocational outcomes, although traditional medical and neuropsychological variables do not. Additional studies are reviewed which examine the impact of gender, race, age, geographic location (i.e., rural vs. urban), and concomitant disabilities on vocational outcomes. Results indicate the importance of considering environmental and social factors when providing vocational rehabilitation services to clients with TBI, and that specific DVR services can lead to successful vocational outcomes regardless of TBI severity. Implications for future clinical services and research are presented.

Objective: To characterize financial and vocational outcomes among persons with traumatic brain injury (TBI) in terms of employment status, earned and private income, and public assistance received at the time of injury and at 1 year after injury., Design: Nonexperimental, longitudinal study., Setting: Inpatient TBI rehabilitation unit and participants' community of residence., Participants: Thirty-five persons with new TBI from 1 national Traumatic Brain Injury Model Systems center., Interventions: Not applicable., Main Outcome Measures: Employment status, earned and private monthly income, and public assistance received monthly at the time of injury and at 1-year follow-up., Results: From the time of injury until 1-year follow-up, the percentage of persons employed decreased from 69% to 31%; the percentage unemployed increased from 11% to 49%; the average earned monthly income declined 51% (from US dollars 1,491 to US dollars 726); and the mean total public assistance received per month increased 275% (from US dollars 153 to US dollars 421)., Conclusion: Assuming that this study sample is representative of national statistics for TBI, during the first year after injury, TBI is associated with an estimated $642 million in lost wages, US dollars 96 million in lost income taxes, and US dollars 353 million in increased public assistance.

Objectives: To determine the characteristics of individuals with traumatic brain injury (TBI) who request state vocational rehabilitation services and to determine the best predictors of their successful vocational outcomes., Design: Observational study., Setting: Vocational services data from the Missouri Division of Vocational Rehabilitation (DVR)., Participants: Seventy-eight individuals with TBI who requested services from the Missouri DVR., Interventions: Not applicable., Main Outcome Measures: Demographic, injury severity, neuropsychologic variables, vocational services offered, and vocational status at time of case closure (successful, unsuccessful, services interrupted, no services provided)., Results: Individuals requesting DVR services were primarily men (71%), white (82%), single (47%), of low average intelligence (Wechsler Adult Intelligence Scales-III full scale IQ score, 84.8), and of limited education (11.8 y). The majority experienced a significant TBI (ie, 66% were hospitalized after their TBI; 56% reported loss of consciousness; 37% reported posttraumatic amnesia; 32% reported multiple TBIs; avg time since injury, 9.2 y). At DVR case closure, 17% were rated as being successfully employed, with nearly all working in industrial, service, or clerical positions (2 in a sheltered workshop, 1 in a professional position). Stepwise logistic regressions indicated that delivery of DVR services (ie, vocational guidance and counseling, on-the-job training) predicted vocational outcome and demographic, injury severity, and neuropsychologic variables did not., Conclusions: DVR clients have multiple impairments that affect them several years postinjury; the provision of DVR services may be more important in determining vocational outcomes than traditional medical, psychologic, and demographic variables.

Objective: To evaluate race differences in demographics, injury severity, and vocational outcomes for persons with TBI., Participants: Seventy-five individuals with TBI (13 African American, 62 Caucasian) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a 2-year period., Measures: Demographics (i.e. age, race, level of education), injury severity (i.e. LOC, PTA, length of hospitalization, neuropsychological test scores), VR services provided (e.g. transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs unsuccessfully employed; cost per case)., Procedure: All participants completed a standard neuropsychological evaluation and completed VR services (i.e. were followed from enrollment to case closure)., Hypotheses: African Americans and Caucasians would not differ in demographics or injury severity, although fewer African Americans would be successfully employed through DVR., Analyses: Chi-squares and non-parametric MANOVAs to evaluate race differences in terms of demographics, injury severity, vocational services provided and vocational outcomes., Results: As hypothesized, there were few race differences in demographics or injury severity, although African Americans received significantly more transportation services (62 vs 21%). Contrary to hypotheses, there was no difference in the number of successfully employed African Americans (23%) vs Caucasians (18%)., Conclusions: African Americans and Caucasians with TBI achieve similar vocational successes if they receive state VR services.

Objective: To evaluate differences in demographics, injury severity, and vocational outcomes for persons with TBI based on rural vs. urban residency., Participants: 78 individuals with TBI (28 from rural counties, 50 from urban counties) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a two year period., Measures: Demographics (i.e., age, race, education), injury severity (i.e., loss of consciousness, post traumatic amnesia, length of hospitalization, neuropsychological test scores), VR services provided (e.g., transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs. unsuccessfully employed; cost per case)., Procedure: All participants completed a standard neuropsychological evaluation and completed VR services (i.e., were followed from enrollment to case closure). Rural and urban residency was determined using U.S Office of Management and Budget definitions of metropolitan and non-metropolitan areas., Analysis: Chi-squares, Fisher's Exact tests, Wilcoxon Rank Sums test, and MANOVAs., Results: Few if any differences were found between the groups in demographics (i.e., more African Americans in urban areas), injury severity (i.e., more rural residents with multiple TBIs), or neuropsychological test scores. However, individuals from urban areas received significantly more maintenance funds (46% vs. 21%), transportation services (36% vs. 11%), and on-the-job training (28% vs. 7%), and had more spent on them ($1,816 vs $1,242). Although statistically non-significant (p < 0.15), 24% of individuals from urban areas were successfully employed at VR case closure, compared to only 7% of individuals from rural areas., Conclusions: Individuals with TBI from rural and urban settings have generally similar demographic, injury severity, and neuropsychological abilities, although they appear to differ in terms of vocational outcomes and number of VR services received, possibly related to limited availability of resources in rural areas.

Objective: To determine the relationship among neuropsychological variables, vocational outcomes, and vocational costs for Missouri Division of Vocational Rehabilitation (MO-DVR) clients with traumatic brain injury (TBI)., Design: Clients referred for neuropsychological evaluations were followed until DVR case closure. Subjects were grouped according to the following DVR status at case closure: Successfully Employed, Services Interrupted, and No Services Provided. Spearman correlations with Bonferroni corrections were calculated to determine relationships among variables, and Kruskal-Wallis nonparametric one-way analyses of variance (ANOVAs) were conducted to evaluate differences in DVR group status in terms of neuropsychological variables and 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 neuropsychological functioning and relative degree of decline in: intelligence (WAIS-R), memory (WMS-R General and Delayed Memory Indices), attention (WMS-R Attention Index), speed of processing (Trails A), and cognitive flexibility (Trails B); DVR costs at closure., Results: 1) Surprisingly, the Successfully 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 significantly correlated with vocational outcomes (5/6) than were indices of absolute functioning (3/6)., Conclusions: DVR is effective in providing services to individuals with the most significant neuropsychological deficits; it is important to consider both absolute level of functioning and relative decline in functioning when evaluating TBI.