Vocational Rehabilitation

Returning to work following ABI is one of the most challenging tasks that a patient will face in the course of their recovery. The work environment often produces stresses on their physical body, cognitive challenges, and emotional strain. However, given the financial burden of not being able to work for most individuals, it is a very important aspect of full reintegration into society and return to independent living. 

Table: Vocational Rehabilitation Post ABI

Discussion

The benefits for patients to enter a vocational rehabilitation program appear to be plentiful and cost-effective. In the cost-benefit analysis by Abrams et al. (1993), 142 persons with TBI participated in the program and found that 65% obtained employment during the first year of entering the program and 75% obtained employment during the entire observation period. This resulted in a 2:1 ratio of total taxpayer benefit to total program operational cost and a 4:1 ratio of total taxpayer benefit to state cost. Results from Foy (2014) were not as high as the previous study, with only 53% of individuals with ABI, who attended the vocational rehabilitation program, achieving a positive vocational outcome (10% achieving full-time education and 8% achieving full-time employment). Klonoff et al. (1998) looked at the adjusted outcome of 64 subjects who participated in the Adult Day Hospital for Neurological Rehabilitation Work/School Re-entry program. At discharge, 89.5% of the subjects displayed fair or good adjusted outcomes. Further, 62.5% were gainfully employed or full-time students at discharge, with 15.6% returning to the same level of work or school as pre-injury (Klonoff et al. 1998).

A systematic review by Tyerman (2012) endorsed individualized programs for return to work. Patients’ characteristics (i.e., physical and cognitive abilities, severity of injury) need to be matched appropriately with the correct type of rehabilitation and intensity. Furthermore, Tyerman (2012) stressed the importance of the patient’s goals, as work may not be their primary goal and premature return to work could potentially cause psychological issues and vocational difficulties. Although streaming according to ability may be beneficial for patients, the results from Johnstone et al. (1999) suggest that even individuals with significant cognitive deficits can benefit from vocational rehabilitation services. Therefore, individuals should not be deemed ineligible for such services based solely on neuropsychological test scores.

There is good reason to believe that vocational programs are useful in assisting patients with moderate to severe brain injury with their vocational goals. In doing so, the benefits to the individual financially, and in terms of their self-esteem, are positive. In addition, there is an obvious savings to the taxpayer to have programs designed towards assisting patients with returning to work.  

Conclusions

There is Level 4 evidence that individualized work re-entry programs are effective.

There is Level 4 evidence that after vocational rehabilitation the majority of subjects have fair or good adjusted outcome, while over one-third become gainfully employed or full-time students.

There is Level 4 evidence that individuals with the most significant cognitive impairments benefit the most from vocational rehabilitation services.  

 

Vocational rehabilitation results in greater total taxpayer benefits than either total program operational costs or government costs.

Participants in vocational rehabilitation often have fair or good adjusted outcome, while more than half become gainfully employed or full-time students.

Individuals with significant cognitive impairments benefit the most from vocational rehabilitation services.