The acquisition of tacts,mands, and intraverbals by individuals with traumatic brain injury

Two individuals who sustained traumatic brain injuries from motorcycle accidents were taught several verbal responses by using tact, mand, and intraverbal training procedures. The rate of acquisition for each operant and the transfer to untrained verbal operants involving the same response topography were measured. The results showed that tacts and intraverbals were acquired quickest, and training on the tact produced the greatest amount of transfer to the untrained verbal operants. Intraverbal training also resulted in transfer for both subjects, but to varying degrees. Direct mand training proved to be the least efficient way to generate a mand repertoire, and when acquired showed least amount of transfer to the untrained operants. These results seem to be in contrast with the findings of similar research with developmentally disabled individuals, and may have implications for methods of language instruction for the brain injured population.

     

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.     

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.     

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 value of employment for people living with spinal cord injury in Norway

The purpose of this article is to examine the value of employment for people living with spinal cord injury in Norway. The main focus in the 31 interviews dealt with general perceptions of integration and participation. The value of employment was a major theme, primarily described by the participants in terms of personal and social identity in interaction with others, as a hegemonic social norm and a sense of moral obligation to contribute to society. The value of meaningful regular jobs – in contrast to government projects jobs or routine jobs – was emphasized.     

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.     

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.     

Patterns of employment among individuals with mental illness in vocational recovery

This article provides empirical evidence about the patterns of competitive employment among individuals with serious mental illness who are in vocational recovery. The findings are based on a 5-year longitudinal study on sustained employment, conducted with a national sample of 529 individuals with serious mental illness who were in vocational recovery at the time of study enrollment. Data analysis from the 328 participants who completed the study-from baseline through all five annual follow-up assessments-revealed three different postrecovery employment patterns: continuous, stable, and fluctuating. Although many participants demonstrated the capacity to sustain competitive employment during prolonged periods of time, others experienced employment interruptions. Work interruptions were most frequently attributed to exacerbation of psychiatric symptoms. Schizophrenia spectrum disorder, difficulties with daily functioning, and current receipt of disability benefits predicted the psychiatric-based work interruptions in this sample. Implications for clinical practice are also discussed.     

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.     

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.     

Sexual abuse of individuals with disabilities: prevention strategies for clinical practice

Sexual abuse of individuals with disabilities occurs in alarming proportions, although the prevalence and incidence of such abuse is difficult to determine. Although all states maintain statistics on child sexual abuse, the rate of victimization for individuals with disabilities is not specific. This paper reviews several studies conducted on sexual abuse of individuals with disabilities with a focus on clinical prevention strategies. Recommendations for future directions in prevention and research are provided.     

Facilitators and barriers to employment among individuals with psychiatric disabilities: a job coach perspective

Unemployment rates remain high among individuals with psychiatric disabilities despite growing evidence that supported employment programs (SEPs) can help such individuals to obtain and retain competitive employment. A complete understanding of factors that may facilitate or hinder the success of such supported employment efforts is urgently needed to increase the efficacy of SEPs and move more individuals with psychiatric disabilities from welfare to work. This exploratory study provides insight into potential facilitators and barriers to employment among individuals with psychiatric disabilities from the perspective of job coaches. Twenty-eight job coaches from 14 SEPs in a Northeastern state reported on their experience with four recent clients, two who were successful in obtaining employment and two who failed, through a semi-structured mail survey. Findings suggest that job coaches use similar strategies to assist clients, but in each case try to tailor specific strategies to client's needs and characteristics. Factors that influence successful job placement and research and policy implications are discussed.     

Vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment program

The objective of this paper is to report on the vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment (SCE) program. A total of 458 subjects enrolled in the present SCE program which was developed on the basis of the Supported Employment Model developed by Wehman [23] and the principles of the Individual Placement and Support (IPS) developed by Becker and Drake [5]. Of the 458 subjects, 308 (67.3%) obtained competitive employment. The mean job tenure was 134 days. The mean salary was $4,740 for full-time jobs and was $2,321 for part-time jobs. The majority of subjects (59.4%) could sustain their job placement for more than 30 days, 74 (24.0%) subjects could work for more than six months, and 38 (12.3%) could maintain the job for more than one year. Subjects who became employed were compared to those who did not gain employment on a variety of demographic variables. Significant differences were found between two groups in terms of sex and source of referral. The rate of employment in the current study was slightly higher, but the job retention rate was lower than in earlier studies. Recommendations for future research on evaluation of the effectiveness of SCE program are suggested.     

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.     

Consumer participation in the employment rehabilitation process: contextual factors and implications for practice

Rehabilitation models of practice have emerged that offer persons' with disabilities opportunities to have an active role in the work entry or re(entry) process. Despite the growth and interest in empowering client involvement in practice, consumer views on the determinants of participation are not fully understood. Thus, consumer feedback on using a self-directed approach to employment rehabilitation was elicited to identify factors integral to their participation in the process. Focus groups were conducted with 35 adult consumers with developmental, mental health, physical and learning disabilities to gain insights into their involvement in a participatory approach to find employment. Content analysis of data revealed barriers and facilitators, which hindered or enabled consumer involvement in the vocational service process. This article discusses the importance of considering issues across the rehabilitation system, practice and lived contexts when implementing participatory approaches in vocational rehabilitation settings.     

Positive employment service - facilitating employment for people living with HIV

As treatments and therapies develop and improve, enhancing life expectancy, Human Immunodeficiency Virus (HIV) has been described by some as a long term chronic condition rather than an acute life threatening illness. As this change occurs, new issues become relevant for the person living with HIV, employment being one of these. In light of this, the Positive Employment Service was developed and implemented to explore and address some of the issues related to employment for people living with HIV. The original concept for the service was primarily focused on vocational rehabilitation; however, it soon became clear that there was a need for a prevocational service facilitating transition and adjustment to productivity roles. The service was developed using approaches from Vocational and Occupational Therapy Models of Practice. This article discusses the challenges of developing and implementing this service and explores the unique perspective that occupational therapy brings to a position of this kind.