Competitive re-employment after severe traumatic brain injury: clinical, cognitive and behavioural predictive variables

Abstract

Primary objective : To contribute to the identification of relationships between the return to pre-trauma competitive activities at the final discharge from rehabilitation facilities, and neuroanatomical, neuropsychological and behavioural data collected at different phases of the recovery from a traumatic brain injury (TBI). Methods and procedures : Thirty-five severe TBI subjects were retrospectively selected from 228 consecutive admissions over a 3-year period, according to pre-morbid, clinical and demographic characteristics matching the established selection criteria, and submitted to comprehensive neurophysiological, intellectual, cognitive and behavioural examinations carried out at different stages of the recovery (acute, subacute and chronic phases). Experimental interventions : Barthel Activity of Daily Living (BADL) index, Wechsler Adult Intelligence Scale-Revised (WAIS-R), checklists aimed to detect cognitive and behavioural dysfunction. Main outcomes and results : TBI subjects successfully re-employed obtained significantly better scores on length of coma and PTA, intellectual status, cognitive functioning and behavioural competence. Other specific measures of injury severity (CT-scan abnormalities, GCS score level, BADL index) resulted as being unrelated to the resumption of pre-trauma competitive activities. Conclusions : Findings seem to confirm the opinion that a significant relationship exists between the initial TBI severity level, especially as indicated by the duration of coma and PTA, and eventual return to work at the final discharge from facilities.