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OBJECTIVE: Determine rates of, and factors predictive of, return to work in patients with civilian traumatic head injuries. DESIGN: Inception cohort study with 1- to 2-year follow-up. SETTING: Hospitalized patients in a level I trauma center. PATIENTS: Three hundred sixty-six hospitalized head-injured subjects who were workers before injury and 95 comparison subjects participated in prospective, longitudinal investigations of employment following head injury. Head-injured and comparison subjects were similar on basic demographics and preinjury employment status. The comparison subjects consisted of patients who sustained traumatic injury to the body but not to the head. MAIN OUTCOME MEASURE: Time taken to return to work following head injury. RESULTS: Survival methodology was used for analysis. Whether patients returned to work and when related to both the characteristics of the injured patients (eg, education, preinjury work history), the severity of head injury and associated neuropsychologic problems, and severity of other system injuries. More precise predictions were possible using the multivariate model. CONCLUSIONS: The present study provides a means of assessing employment potential predictively. This can be useful for clinical and research purposes. The results should be used cautiously and should stimulate discussions of appropriate use of services and resources to meet individual patients' needs.

This study examines the relationship of tested vocational aptitudes to measures of neuropsychological functioning in an epilepsy rehabilitation setting. Subjects were 83 adults with epilepsy receiving outpatient care at a large urban medical facility. All were administered the Neuropsychological Battery for Epilepsy and the General Aptitude Test Battery (GATB). Data analysis includes the construction of three correlational matrices comparing vocational aptitude measures with measures of intellectual and neuropsychological functioning. A stepwise linear regression analysis was used to explore the degree to which GATB variables might approximate an overall measure of neuropsychological impairment. Consistent, moderately high correlations were found between GATB aptitude scores and overall measures of intellectual and neuropsychological functioning. GATB aptitudes measuring numerical ability, spatial abiity, and motor speed coordination were found to be significantly related to a measure of overall neuropsychological impairment. While this relationship was not strong enough to allow accurate prediction of impairment level using GATB scores alone, it was concluded that the GATB demonstrates correlations with measures of overall neuropsychological and intellectual status that are worthy of note to epilepsy rehabilitation workers.

The performance of adults with epilepsy on the General Aptitude Test Battery (GATB) was explored, with an emphasis on later employment outcome and on vocational counseling implications. The study sample had mean GATB scores which were significantly lower than the published GATB norms. They were also significantly lower than the GATB means obtained from comparison groups comprised of job applicants in the local general labor force and of persons receiving services from the local state rehabilitation agency. Mean scores for measures of dexterity and motor speed were especially low. It was found that GATB scores alone are not highly predictive of employment outcome, although subjects who did not enter competitive employment did tend to have lower mean scores. GATB patterns which may be indicative of lateralized cerebral dysfunction are discussed, along with case studies.

This article summarizes the results of a counselor function survey developed and administered to Region X VR counselors (N = 78) attending a University of washington medical school course on severe disabilities. Counselors were asked to review each of 1:5 counselor functions and provide time investment and complexity ratings. Relationships between counsellor demographic characteristics and perceptions of function complexity or time spent were also investigated. Results indicate that counseling and planning with clients, in addition to case reporting and recording, are functions which are perceived as consuming substantial portions of the work week (20% and 16%, respectively). Of these functions which seem to require more time, only the counseling and planning funotion approximates a highly complex rating. As contrasted with previous studies, results suggest slightly less time spent in counselor-client interaction and reduced time spent in professional growth activities or public relations and resource development efforts in the community. Implications for the utilization of counselor function surveys are discussed.

The job-related difficulties of those with epilepsy are well documented in the literature. These clients with epilepsy have traditionally had difficulty benefiting from contact with the state-federal rehabilitation systems. The key to successful placement in epilepsy rehabilitation is comprehensive evaluation as a baseline. The neurological impairment that can be associated with the disability makes this even more imperative. The major thrust of this article is a description of the kinds of data that need to be collected and counseling issues the counselor may need to address. Following comprehensive evaluation and active involvement in a rehabilitation plan, the person with epilepsy may be among the more employable individuals entering the rehabilitation system. Various programs specializing in epilepsy rehabilitation have achieved placement rates of 50% and higher.