The best practice for gaining and maintaining employment for individuals with traumatic brain injury

There are currently 5.3 million Americans with traumatic brain injury, the majority were young at onset and have a lengthy life expectancy. Return to work is a key to quality of life for many of these individuals. This article provides a literature review of current traumatic brain injury vocational rehabilitation programs including: holistic cognitive rehabilitation, school to work transition, and supportive employment followed by a proposal for the best practice.     

Evaluation of single and mixed verbal operant arrangements for teaching mands and tacts

The purpose of this series of experiments was to evaluate the effects of mixed mand-tact arrangements on the acquisition of mands and tacts in preschool-aged children. In Experiment 1, the effects of three training arrangements (mand-only training, tact-only training, and mand-tact training) were investigated with 3 typically developing children. Rates of acquisition in single (mand-only and tact-only) versus mixed (mand-tact) presentation were comparable, in contrast to earlier investigations. Experiment 2 attempted to clarify the equivocal findings of Experiment 1 by directly replicating the Carroll and Hesse (1987) investigation with 2 typically developing children. Results again demonstrated no clear benefit of mixed verbal operant training on tact acquisition. In Experiment 3, these same arrangements were evaluated with a boy with autism and included assessments to determine that a relevant establishing operation was in effect prior to each mand training session. Experiment 3 again failed to demonstrate the facilitative effects of mand-tact training on the acquisition of mands or tacts. Taken together, the data from these three experiments fail to support the improved efficiency of mand-tact training suggested by prior studies. Findings are discussed in the context of future research investigating mixed verbal operant arrangements.     

The effects of alternating mand and tact training on the acquisition of tacts

Two training procedures were compared with respect to the average number of training trials it took to teach new verbal responses to normal children. Mand contingencies were alternated with tact contingencies in one condition while only tact contingencies were in effect in the other condition. Normal, preschool children served as subjects and toy parts were the objects that were to be named. The results indicated that it took, on the average, fewer trials to teach part names (tacts) in the mand-tact condition than in the tact only condition. Although more research is needed to confirm this, it appears that mand contingencies involve stronger controlling variables and can facilitate the acquisition of a tact repertoire.

     

Neuropsychiatric complications of traumatic brain injury

Traumatic brain injury (TBI) may be defined as any extracranial mechanical force to the brain that results in any period of loss of consciousness, any loss of memory for events immediately before or after the event, or any alteration in mental status at the time of the event. The major causes are automobile accidents, falls, sporting injuries, and assaults. Many soldiers returning from combat in Afghanistan and Iraq have also experienced TBI. This article provides an overview of the neuropsychiatric complications of TBI, including impairment of consciousness, posttraumatic amnesia, cognitive disorders and dementia, posttraumatic epilepsy, aphasia, depression, mania, psychosis, anxiety disorders, personality changes, aggression, behavioral dyscontrol, fatigue/apathy, and increased risk of suicide. Discussion will focus primarily on issues affecting mental health clinicians. Because mental health providers are more involved in care of chronic issues related to TBI, these issues will be discussed in more detail, although acute neuropsychiatric complications of TBI will be briefly explained.     

Work-related mild-moderate traumatic brain injury and the construction industry

Background: Consequences of traumatic brain injury underscore the need to study high-risk groups. Few studies have investigated work-related traumatic brain injuries (WrTBIs) in the construction industry. Objective: To examine WrTBIs in Ontario for the construction industry compared to other industries. Methods: A retrospective study of individuals who sustained a WrTBI and had a clinical assessment as an outpatient at a hospital-based referral centre. Data were collected for a number of factors including demographic, injury and occupation and were analyzed according to the Person-Environment-Occupation (PEO) model. Participants: 435 individuals who sustained a WrTBI. Results: There were 19.1% in the construction industry, 80.9% in other industries. Compared to other industries, individuals in the construction industry were more likely to be male, to not have attained post-secondary education, and experience multiple traumas. WrTBIs in the construction industry were commonly due to elevated work. The construction occupations involved included skilled workers and general labourers, and compared to other industries, WrTBIs occurred most often for those employed for a short duration in the construction industry.Conclusions: Construction industry workers experience serious WrTBIs that are amenable to prevention. Use of the PEO model increased our understanding of WrTBIs in the construction industry.     

Dealing with the 'Void': traumatic brain injury as a story

Traumatic brain injury (TBI) is considered to drastically affect the individual's sense of self. To discover how people with TBI understand themselves, in-depth interviews with four individuals with TBI were conducted. Their narratives suggest that they feel they are carrying a 'void' in their understandings of their past and present. Individuals tend to fill the 'void' in their long-term memory with stories about the accident and recovery. The concept of 'void' is also useful in understanding how TBI survivors view the causal relationship between the accident, the brain injury and their present difficulties. This relationship can be another 'void' that threatens their sense of agency. The findings suggest that the experience of TBI appears as meanings in their self-narratives rather than as objective truth. Rehabilitation professionals should consider how their client interprets his or her TBI and self in everyday life when they work with this population.     

The family caregiving context among adults with disabilities: A review of the research on developmental disabilities,serious mental illness,and traumatic brain injury

ABSTRACT

A majority of adults with serious disabilities are cared for in the home by family members. Guided by an ecological framework, this article presents the findings of a literature review of research on family caregiving and family support for adults with disabilities. This review included 33 research studies published between 2000 and 2015 focused on three disabilities: Developmental disabilities, serious mental illnesses, and traumatic brain injury. A synthesis of the findings underscores the critical role that family caregivers occupy in addressing the needs of their loved one with a disability; however, the needs of the caregiver are insufficiently met by existing service approaches. A better understanding of the unique needs and strengths of the family support context of caregivers and care recipients is needed, giving greater attention to ethnic, racial, and cultural considerations in future research.     

Workplace discrimination and traumatic brain injury: the national EEOC ADA research project

Using the Integrated Mission System of the Equal Employment Opportunity Commission, the employment discrimination experience of Americans with traumatic brain injury is documented. Researchers compare and contrast the key dimensions of workplace discrimination involving Americans with traumatic brain injury and persons with other physical, sensory, and neurological impairments. Specifically, the researchers examine demographic characteristics of the charging parties; the industry designation, location, and size of employers against whom complaints are filed; the nature of discrimination (i.e., type of adverse action) alleged to occur; and the outcome or resolution of the investigations. Findings indicate that persons with traumatic brain injury were more likely to encounter discrimination after obtaining employment as opposed to during the hiring process. They were also more likely to encounter discrimination when they were younger or Caucasian or when employed in the Midwestern or Western United States. Implications are addressed.     

Cognitive and behavioural assessment of people with traumatic brain injury in the work place: occupational therapists' perceptions

Cognitive and behavioural impairments, in the absence of severe physical disability, are commonly related to poor return to work outcomes for people with traumatic brain injury (TBI). Along with other health professionals, occupational therapists make judgements about cognitive and behavioural dimensions of work capacity of clients with TBI during the return to work process. Unlike many physical functional capacity evaluations, there is no standard method that therapists use to assess the ability of people with TBI to perform cognitive operations required for work. Little is known about what information occupational therapists use in their assessment of cognitive and behavioural aspects of client performance within the work place. This study employed qualitative research methods to determine what information is utilised by 20 therapists who assess the work capacity of people with TBI in the workplace. Results indicated that the process of making judgements about cognitive and behavioural competence within the work place is a multifaceted process. Therapists triangulate client information from multiple sources and types of data to produce an accurate view of client work capacity. Central to this process is the relationship between the client, the job and the work environment.     

The challenges of a hidden disability: Social work practice in the field of traumatic brain injury

Abstract

Traumatic brain injury (TBI) has become an important area for social work practice. Children and adults sustaining TBI often undergo hospitalisation, rehabilitation and face the prospect of lifelong cognitive and psychosocial impairments. Families are profoundly affected by the consequences of the injury. TBI is a ‘hidden disability’ because there are typically no physical markers indicating a person has brain damage. This paper aims to provide some guidelines for social work practice in the area, in particular, outlining options for social work interventions at individual, family, community, service system and policy levels. Social workers need to acquire specialised knowledge about brain injury, reformulate traditional models of grief counselling to address the adjustment challenges and utilise community education and service innovation to address the social stigma and reduced level of community participation associated with brain damage. Finally, social workers aim to nurture a sense of hope in the face of the tragedy.     

Investigating metacognition,cognition, and behavioral deficits of college students with acute traumatic brain injuries

ABSTRACT

Objective: Executive dysfunction in college students who have had an acute traumatic brain injury (TBI) was investigated. The cognitive, behavioral, and metacognitive effects on college students who endorsed experiencing a brain injury were specifically explored. Participants: Participants were 121 college students who endorsed a mild TBI, and 121 college students with no history of a TBI were matched on sex and ethnicity to examine potential differences between groups. Methods: Participants completed the Dysexecutive Questionnaire (DEX). Results: A Rasch analysis indicated that the TBI group had significantly higher total scores on the DEX than the control group. Moreover, when compared with the control group, the students with a TBI had higher scores on all 3 subcomponents of the DEX. Conclusion: These findings suggest that students who endorse brain injuries may experience more difficulty with specific facets of college. Thus, the importance of academic and personal resources available for students with a TBI is discussed.     

Interpersonal relatedness and psychological functioning following traumatic brain injury: implications for marital and family therapists

Recovery from a mild-to-moderate traumatic brain injury (TBI) is a challenging process for injured persons and their families. Guided by attachment theory, we investigated whether relationship conflict, social support, or sense of belonging were associated with psychological functioning. Community-dwelling persons with TBI (N = 75) and their relatives/significant others (N = 74) were surveyed on relationship variables, functional status, and TBI symptom severity. Results from this cross-sectional study revealed that only sense of belonging was a significant predictor of postinjury psychological functioning, although interpersonal conflict approached significance. No relevant preinjury or injury-related variables impacted these relationships, except marital status. Our findings suggest that interventions targeting strengthening the injured persons' sense of belonging and lowering interpersonal conflict may benefit those living with TBI.     

Diagnosing and treating traumatic brain injury among veterans of the Afghanistan and Iraq wars: implications for social work

Traumatic brain injury (TBI) is a serious condition affecting many American veterans who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Using a biopsychosocial perspective, the authors delineate and discuss the challenges of diagnosing and treating this neurological disability among soldiers who have returned to the United States from combat theaters in the Middle East. They explain recent changes including the Veterans Affairs Polytrauma System of Care, as well as social work's role on the interdisciplinary team who promote rehabilitation and community reentry for OEF/OIF veterans with TBI.     

Visual metaphors of living with brain injury: exploring and communicating lived experience with an invisible injury

Brain injury can affect cognitive, emotional and physical functioning – consequences that pose challenges to understanding survivors' perspectives on their lives. Furthermore, the injury may be invisible, even clinically, causing additional confusion for affected individuals, family members, co-workers and clinicians. The present study used photovoice with adult brain injury survivors so they could communicate their lived experience. Participants took photographs, discussed them, and selected some for captions. Half of their selected images are visual metaphors that foster a multifaceted view of brain injury with room for negative as well as positive aspects of their experience. Photovoice provided opportunities to communicate a personal voice during group discussions and in study binders, and a group voice in outreach products. Visual metaphors became vehicles for voice as participants used photovoice to make visible their brain injuries and their efforts to wrestle with the impacts and discover new purpose and meaning in life.     

The acquisition,development, and maintenance of fruit machine gambling in adolescents

In the U.K., the major commercial gambling activity in adolescents is the playing of slot machines (commonly known as “fruit machines”). Over the past few years, the negative effects of “fruit machine addiction” have been reported by various helping organizations (e.g. Gamblers Anonymous) and the national press, including allegations of attempted murder, suicide and prostitution as well as a wider incidence of petty crime. Fifty adolescent fruit machine players from a ‘user population’ participated in a face-to-face interview and questionnaire study examining factors in the acquisition, development and maintenance of gambling behaviour. Nine adolescent males were deemed to be pathological gamblers as measured by the American Psychiatric Association DSM-III-R diagnostic criteria, and a number of serious consequences were reported including gambling debts, truancy and stealing.     

The effects of listener training on the emergence of tact and mand signs by individuals with intellectual disabilities

The purpose of the current study was to assess whether individuals with intellectual disabilities would emit untrained speaker responses (i.e., signed tacts and mands) after being taught listener behaviors. Listener relations were trained via an automated matching-to-sample (MTS) procedure. Following mastery, the emergence of signed tacts, generalized tacts, and mands was tested. All participants met criterion in listener relations training and showed the emergence of almost all relations. Results suggest that teaching listener relations first, through MTS tasks, is a viable way to produce emergence of speaker relations.     

Secondary traumatic stress, psychological distress, sharing of traumatic reminiscences, and marital quality among spouses of Holocaust child survivors

In this study, we examined the issue of secondary traumatic stress (STS) among spouses of Holocaust survivors who were children during the World War II. STS is defined as comprising the same components as posttraumatic stress disorder (PTSD), except that the person evidencing the symptoms has not actually been exposed to the traumatic event(s), but has developed them as a result of caring for someone with PTSD. Participants were 90 couples who completed self-report questionnaires regarding posttraumatic symptoms, psychological distress, and marital quality. The results showed that about one-third of the spouses suffered from some degree of STS symptoms. Secondary traumatic stress symptoms and psychological distress among spouses were significantly related to hostility, anger, paranoia, and interpersonal sensitivity in the survivor, but unrelated to whether the survivor had shared his/her reminiscences with the spouse. Female spouses were found to suffer more distress than male spouses, especially when their partner suffered high levels of PTSD. The results suggest that STS is, to a large degree, related to the demands of living with a symptomatic survivor, possibly more than to the empathic element thought to be central to this syndrome.     

Prediction of vocational outcome of people with brain injury after rehabilitation: a discriminant analysis

Due to advancements in emergency evacuation procedures and neurosurgical techniques, more patients with brain injury (BI) can survive cerebral injury and regain a satisfactory degree of recovery through rehabilitation. Their improvement in physical and cognitive functions can facilitate their reintegration into the community, especially their return to work (RTW). Different factors were reported to affect this rate of RTW in previous studies. This retrospective study thus aimed to investigate the role of demographic data, the severity of injury, residual physical deficits, activities of daily living, and cognitive function using a stepwise discriminant function analysis (DFA). Data sets for 79 persons with BI were retrieved so as to identify predictors of their vocational outcomes upon discharge and during a follow-up period. The stepwise DFA revealed that the discharge score on the Disability Rating Scale (DRS), the attention-subtest of the Neurobehavioral Cognitive Status Examination (NCSE) or Cognistat, and pre-morbid occupation were significant predictors that correctly classified 65.8% of the subjects.