Article Details

Research Database: Article Details

Citation:  Kowalske, K., Plenger, P. M., Lusby, B., & Hayden, M., E. (2000). Vocational reentry following TBI: An enablement model. The Journal of Head Trauma Rehabilitation, 15 (4), 989-999.
Title:  Vocational reentry following TBI: An enablement model
Authors:  Kowalske, K., Plenger, P. M., Lusby, B., & Hayden, M., E.
Year:  2000
Journal/Publication:  The Journal of Head Trauma Rehabilitation
Publisher:  Lippincott Williams & Wilkins, Inc.
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  Not reported

Structured abstract:

Background:  Environmental factors are at the heart of many performance problems after traumatic brain injury (TBI). This vulnerability negatively affects the ability of the patient to generalize treatment gains made in an artificial clinic environment to more naturalistic settings like home and work. It also impacts the rehabilitation professional's ability to predict the performance of a patient in these and other real world settings. Rehabilitation efforts that make patient environmental interactions part of the treatment plan will increase generalization and predictability. Rehabilitation efforts should include data-based definitions of the environment(s) within which each individual can best function. Also important is a focus on the tasks that he or she can perform within those environment(s). When a discharge goal is to return to work, rehabilitation efforts must include: identifying job settings where enabling environments can be established and providing ongoing support to the individual in the job situation should the environment change. More research is needed on the use and benefits of an environmentally focused treatment model.
Purpose:  The purpose of this paper was twofold. First it described a treatment program for individuals with brain injury that focuses heavily on patient–environment interactions, both during treatment and after discharge and provide illustrative case examples.
Setting:  The interventions took place in the clinical setting and the individuals' places of employment.
Study sample:  The study examined the experiences of three individuals with TBI who received varying levels of support to return to work. More specific, they demonstrate how treatment environments were initially configured and then modified during treatment as the patients returned to work. The case studies were selected from an overall sample of 57 individuals with TBI. All three patients had extremely severe neurocognitive dysfunction.
Intervention:  The three interventions were part of an environmentally focused treatment model. Preliminary steps for each involved a) contacting an employer about a patients return to work for those employed at the time of injury or if the person was not employed or does not want to return to work a job developer gets involved to develop work options in an environment where the person is most likely to optimally perform and b) a rehab staff member conducts a job site visit in order to gain an understanding of environmental factors that may impact success on the job. The first intervention teaches a patient to structure environments. Clinic staff make an initial job site visit and may have some ongoing contact with the employer, but the patient has primary responsibility for structuring the work environment. The second intervention is reserved for a patient who is incapable of assuming primary responsibility for structuring his own environments. Therefore, the rehabilitation staff play a major role in developing an enabling environment. This makes vocational placement easier. The third intervention involves creating a highly structured work environment for a extremely compromised patient, by educating the family throughout the rehabilitation process. The family then supplies the ongoing structure and limits distractions, as necessary, to maximize the person's performance.
Data collection and analysis:  No specific data was collected or analyzed. Three case studies illustrated three interventions to help individuals with TBI with returning to work.
Findings:  It is clear that the successful vocational re-entry depicted in these cases required close attention to each patient's specific strengths and weaknesses as they related to specific environmental factors, especially the levels and types of structure and distraction that were inherent in the environment. It seems that specialized, individualized treatment that focuses on the patients' strengths and weaknesses and on environmental factors, like the degree of structure and distractions, can enable return to work for individuals with severe TBI.
Conclusions:  Environmental factors impact the ability of individuals with TBI to return to work. Individualized treatment that focuses on how structure and/or distractions impact work performance can be used to help individuals with TBI return to work.

Disabilities served:  Traumatic brain injury (TBI)
Populations served:  Gender: Female and Male
Interventions:  Environmental modifications
Job search and placement assistance
On-the-job training and support
Outcomes:  Employment acquisition
Return to work