Work - Volume 36, issue 4

Article Type: Other

DOI: 10.3233/WOR-2010-1038

Citation: Work, vol. 36, no. 4, pp. 371-372, 2010

Authors: Precin, Pat

Article Type: Research Article

Abstract: Objectives: This case study report investigated the use of visual imagery to enhance sequencing of a work task in an individual with executive functioning impairment due to Asperger's Syndrome. Participant: This individual's job was at risk due to his inability to correctly sequence his assigned work task in a busy pizza parlor. Methods: Visual imagery training was administered to the client at work by a therapist employed as a job coach. Results: After six 15 minute daily sessions …of visual imagery training, the client was able to perform the work task independently. Conclusions: The use of visual imagery may have been associated with the ability of this individual to perform more independently on this job task. Show more

Keywords: Executive functioning, job coach, occupational therapy, employment, disability

DOI: 10.3233/WOR-2010-1040

Citation: Work, vol. 36, no. 4, pp. 373-379, 2010

Authors: Ownsworth, Tamara

Article Type: Research Article

Abstract: Objective: To describe the implementation of a metacognitive contextual approach for facilitating return to work for individuals with acquired brain injury (ABI). Participants: Participants included three individuals with ABI (one male aged 33 years with head injury, one male aged 51 years with stroke, and one female aged 43 years with head injury) who were 3–7 years post-injury and were experiencing long-term unemployment. Methods: Individuals participated in a 16-week metacognitive contextual intervention in …the community that emphasized executive strategy training and enhancement of social contextual factors in the return to work process. Results: Each participant met their employment goals, achieving a paid work placement within a 3–16 week period following the intervention with durable outcomes. The participant with a less positive employment prognosis attained a faster work placement than the other participants but required more intensive on-the-job support. Conclusions: This study provides preliminary support regarding the efficacy of a metacognitive contextual approach in vocational rehabilitation following ABI. Show more

Keywords: Acquired brain injury, employment, metacognitive contextual approach, vocational rehabilitation

DOI: 10.3233/WOR-2010-1041

Citation: Work, vol. 36, no. 4, pp. 381-388, 2010

Authors: Bade, Suzanne

Article Type: Research Article

Abstract: Cognitive executive functions have significant implications for quality of life and succeeding at home, in the community and at work. This paper reviews the return to work of an internationally acclaimed professional who was medically treated for the physical effects of a brain aneurysm, but whose resulting cognitive deficits were not identified until he experienced failure at work and accompanying depression and anxiety. Review of the Occupational Therapy Work Services includes the accommodations, strategies and …client-centered collaborative efforts that led to enduring success at home, the community and work. Show more

Keywords: Work, brain injury, occupational therapy, rehabilitation

DOI: 10.3233/WOR-2010-1042

Citation: Work, vol. 36, no. 4, pp. 389-398, 2010

Authors: Hartmann, Kimberly D.

Article Type: Research Article

Abstract: This case study describes the changes in the quantity of work production of a 32 year-old male paralegal secondary to a mild brain injury from a racquetball racket blow to the frontal lobe area. The case illustrates how a work analysis can serve as an effective evaluation tool and how the utilization of assistive technology can circumvent executive functioning challenges and improve work production and client self-reported self-esteem. This evaluative and intervention process may be highly …effective in mild-brain injury where executive functioning disorders cannot be identified through typical methods. Yet a detailed comparison of work productivity pre and post injury through work samples, interviews, and observations may be a powerful system to differentiate changes in executive functioning. Show more

Keywords: Compensatory tools, text to speech, electronic note taking

DOI: 10.3233/WOR-2010-1048

Citation: Work, vol. 36, no. 4, pp. 399-404, 2010

Authors: Wolf, Timothy J. | Stift, Stefanie | Connor, Lisa Tabor | Baum, Carolyn | The Cognitive Rehabilitation Research Group,

Article Type: Research Article

Abstract: Objective: The goal of this study was to test the feasibility of administering subtests of the EFPT to stroke survivors in the acute phase of stroke to detect executive function deficits. Participants: A population of adults with mild to moderate stroke (N=20). Methods: This study employed a cross-sectional design using the EFPT and a neuropsychological battery immediately post-stroke. Results: Overall EFPT performance significantly correlated with 3 of the 13 DKEFS scaled scores: Sorting (r=−0.511, p=0.030), …Verbal Fluency (r= −0.474, p=0.035) and Color-Word Interference (r= −0.566, p=0.011) and the Short Blessed Test (r = 0.548, p=0.012). Multiple significant correlations were also found between EFPT-bill paying and cooking subtests and DKEFS subtests. Conclusions: Performance on the EFPT one-week post stroke was very similar to what was found in a prior study validating the EFPT in stroke survivors at 6-months post-onset. The results of this study provide evidence to the support conducting a follow-up study in the acute care setting using the bill paying subtest of the EFPT along with a neuropsychological battery, to augment discharge planning. Show more

Keywords: Acute stroke, cognitive dysfunction, performance-based testing

DOI: 10.3233/WOR-2010-1045

Citation: Work, vol. 36, no. 4, pp. 405-412, 2010

Authors: Matheson, Leonard

Article Type: Research Article

Abstract: Objective: To study whether severity of traumatic brain injury and the intelligence quotient are related to executive dysfunction. Participants: Sixty-two adults with brain injury who were referred for a work capacity evaluation. Methods: Retrospective review of severity of traumatic brain injury, intelligence quotient from a previously-conducted neuropsychological evaluation, determination of executive function status from the neuropsychological evaluation, and both self-report and informant-report executive dysfunction scores from the Behavior Rating Inventory of Executive …Function. Results: Executive dysfunction and the intelligence quotient are related to severity of traumatic brain injury, but executive dysfunction and the intelligence quotient are not related to each other. Executive dysfunction as determined by a neuropsychological evaluation was not consistent with clients' self-reports but was consistent with informant-reported executive dysfunction. Five types of executive dysfunction were reported by knowledgeable informants, with significant elevations on the Shift, Plan/Organize, Task Monitor, Organization of Materials, and Working Memory BRIEF clinical scales. Conclusions: The intelligence quotient is not a useful indicator of executive dysfunction. Informant-report executive dysfunction is a reliable and potentially useful adjunct to a neuropsychological evaluation. Working memory is the most severe type of executive dysfunction and may not be adequately measured by current neuropsychological evaluation methods. Show more

Keywords: Traumatic brain injury, IQ, disability, executive function, executive dysfunction, dysexecutive syndrome

DOI: 10.3233/WOR-2010-1043

Citation: Work, vol. 36, no. 4, pp. 413-422, 2010

Authors: O'Neill, Kelly | Wolf, Timothy J.

Article Type: Research Article

Abstract: Objective: To develop a work readiness assessment battery that can be used in the course of work rehabilitation and to pilot test the battery to determine its ability to measure the effectiveness of work rehabilitation treatment. Participants: All participants were recruited from the patient population at the Occupational Performance Center (OPC) at The Rehabilitation Institute of St. Louis (TRISL) (n= 7). Methods: A work readiness assessment battery was constructed using the Readiness …to Return to Work theory and then pilot-tested using a repeated-measures design. Results: Participants showed significant improvement on all measures including in the battery with the exception of the depression measure. Conclusions: These results demonstrate that it is feasible to construct a work readiness battery of assessments using the Readiness to Return to Work theory and that the measures included capture the effect of work rehabilitation on the constructs identified in the literature to effect work performance. Further investigation is necessary to validate this form of assessment for use in a work rehabilitation setting. Show more

Keywords: Work rehabilitation, stroke, readiness to return to work

DOI: 10.3233/WOR-2010-1046

Citation: Work, vol. 36, no. 4, pp. 423-430, 2010

Authors: Hofgren, C. | Esbjörnsson, E. | Sunnerhagen, K.S.

Article Type: Research Article

Abstract: Objectives: There is great variability in the rate of return to work for persons who have suffered from brain injury. The aims of this study was: 1) to describe employment status of persons with stroke or traumatic brain injury, one year after the incident and 2) to investigate the impact of injury/stroke severity, length of stay, the ability to perform activities of daily living and cognitive function on return to work. Participants and Methods: Information was collected from …72 persons; 48 with a diagnosis of stroke and 24 with a traumatic brain injury. All patients had attended to a Rehabilitation Centre with inpatient and outpatient facilities. Data of the above mentioned variables was gathered retrospectively and information about employment status was retrieved from the medical records. Results: After one year, 13 persons (≈ 18%), 5 with a stroke and 8 with a traumatic brain injury (one with mild brain injury, 9 with moderate and 3 persons with severe injuries) had returned to work. They had significantly shorter length of stay at the rehabilitation hospital and were younger than those that did not return to work. Somewhat better results at the neuropsychological screening were seen among those that returned to work, although with a significant difference only in the subscale assessing affect. Some persons with severe injury returned to work, while a majority of those with mild brain injury did not. Conclusion: Traumatic brain injury, younger age and less need of rehabilitation were associated with a higher rate of returning to work. Patients with stroke were older and seem to need more support in order to be successful in work return. It is of importance to reach primary rehabilitation goals, such as being ADL independent, as this was also favourable for work return. The impact of injury severity seemed complex and should to be further explored. Persons with mild brain injury should be followed-up with respect to work return. An important cognitive factor was ability to perceive and express affective responses, reflecting the need of social skills in today's work-life. Show more

Keywords: Stroke, TBI, cognition, ADL, vocational, outcome

DOI: 10.3233/WOR-2010-1039

Citation: Work, vol. 36, no. 4, pp. 431-439, 2010

Authors: O'Brien, Allyson N. | Wolf, Timothy J.

Article Type: Research Article

Abstract: Objective: To assess the work outcomes of individuals who have a mild to moderate stroke. Participants: Individuals who (1) experienced a mild to moderate stroke as determined by the National Institutes of Health Stroke Scale (NIHSS) scores (range 0–16); (2) were working full time prior to their stroke; and (3) were between the ages of 30–65. Methods: Participants were contacted and provided verbal consent to complete the Occupational Outcome Questionnaire (OOQ) over the telephone at 6 months …post-stroke to determine their work outcomes. Results: Of the 98 participants recruited for this study, 37% (n = 36) never returned to work following stroke. Of the 63% (n=62) who did return to work, 90% (n =56) returned immediately to their previous jobs at their previous level. Of those returning to work, 56% (n= 35) of individuals reported performing at 75% of their ability or less. Further, the majority of all participants reported chronic symptoms from their strokes. Conclusions: The current assumption in the literature is that individuals experiencing mild to moderate strokes are returning to work even in the absence of work rehabilitation services. The assumptions of previous literature can be disputed with the results of the current study. Show more

Keywords: Stroke, return to work, executive function

DOI: 10.3233/WOR-2010-1047

Citation: Work, vol. 36, no. 4, pp. 441-447, 2010

Authors: Dodson, Matthew B.

Article Type: Research Article

Abstract: Impairment in executive functioning can occur after mild stroke, mild Traumatic Brain Injury, and neurodegenerative disease, and this can have deleterious effects on employment outcomes, occupational functioning, and general quality of life. What is not as well identified is the symbiotic relationship between executive functioning and other important psychosocial constructs inherent in successful employees ("Employee Performance Enablers"), and how various aspects of the employment environment can enable or inhibit the success of …the employee with executive functioning deficits in meeting their essential job functions ("Workplace Ecology"). From an extensive review of the literature and the author's practice experience, a clinical model was developed to elucidate these two critical variables, as well as to provide guidance for organizing, planning, and implementing interventions that will address both employee enablers and workplace ecology to affect positive return to work outcomes for individuals with mild brain injury. Show more

Keywords: Executive Function, Return to Work, Employee Performance Enablers, Workplace Ecology

DOI: 10.3233/WOR-2010-1044

Citation: Work, vol. 36, no. 4, pp. 449-457, 2010

Authors: Wolf, Timothy J.

Article Type: Other

Keywords: Executive function, work rehabilitation, participation

DOI: 10.3233/WOR-2010-1049

Citation: Work, vol. 36, no. 4, pp. 459-463, 2010