Article Details

Research Database: Article Details

Citation:  Artman, L. K. & McMahon, B. T. (2013). Functional limitations in traumatic brain injury and their relationship to job maintenance following work re-entry. Journal of Vocational Rehabilitation, 39 (1), 13-21.
Title:  Functional limitations in traumatic brain injury and their relationship to job maintenance following work re-entry
Authors:  Artman, L. K. & McMahon, B. T.
Year:  2013
Journal/Publication:  Journal of Vocational Rehabilitation
Publisher:  IOS Press
DOI:  https://doi.org/10.3233/JVR-130638
Full text:  https://content.iospress.com/download/journal-of-vocational-rehabil...   
Peer-reviewed?  Yes
NIDILRR-funded?  Not reported
Research design:  Database mining

Structured abstract:

Background:  Meeting the demands of work can be difficult for many individuals with traumatic brain injury (TBI), as the individual may have functional limitations, which are a direct residual symptom of their injury. The functional limitations include a broad range of symptoms, including sensory, gross and fine motor, physiological, communication, emotional, and cognitive impairments. These symptoms can vary in type, length at which they occur, and severity. In addition to these functional limitations, an individual with traumatic brain injury may suffer from anxiety or depression or changes in personality. Research shows that the cognitive and emotional deficits are the most common and hindering in regards to employment for individuals with traumatic brain injury. The Job Accommodation Network Information System (JANIS) is the course of data for this article. The Job Accommodation Network (JAN) has compiled the JANIS database. JAN is located in Morgantown, West Virginia and is a service of the Office of Disability Employment Policy of the United States Department of Labor. Through telephone, email, and online chat JAN consults across the nation and provides technical assistance about Employment Provisions, or Title I of the Americans with Disabilities Act. Technical assistance about the responsibilities of employers and the rights of employees under the ADA, customized accommodations in the workplace, assistive technology, and the reasonable accommodation process are some of the services offered by JAN. The information gathered by the JAN consultant through phone calls, chats, and emails are input into the JANIS database.
Purpose:  The purpose of this study is to look at the self-reported functional limitations in relation to job maintenance for individuals with traumatic brain injury who have gone back to work. The main focus of this study is to determine the role functional limitations play in job maintenance.
Study sample:  The sample for this study was formed by using specific data fields in the JANIS database. Caller description, or the role of the person who contacts a JAN consultant, causative factors, or the health condition of the individual with a disability, limitations, or the functional limitations reported by the individual with the disability, and career status, meaning the career status of the individual with a disability at the time of consultation with JAN, were used in this study. Using these data fields, the study sample was then formed using the following criteria: causative factors of TBI were reported by the individual with the disability (comorbid diagnoses were excluded from this study, unless it was a direct result of the TBI and listed in the case notes) and the person who contacted JAN was the individual with TBI; functional limitations were found in the Limitations field or could be found in the case notes; and the individual with TBI had returned to the workforce since the injury, but the individual may have been separated from work (students and self-employed individuals were excluded from this study). The eligibility date for cases started from December 31, 2008 and the earliest case was from January 3, 2002. The geographic distribution of the study sample was determined by recording the state in which the client contacting JAN resides. 160 cases total were used in the study, with 39 states and Washington, D.C. being represented in 156 of the cases. Four cases reported “location unknown”.
Data collection and analysis:  Files that met the study criteria were extracted and exported into Microsoft Excel. Multiple cases from the same client were merged into one case, with all of the functional limitations from each case listed and the most recent employment listed. After the compilation of cases into Excel, the cases were reviewed to ensure that functional limitations were listed and the most recent job status was verified. Case notes were used, when needed. Corresponding indicator variables were assigned and used to code the cases. A client whose job was terminated, had resigned, or took an extended leave of absence was viewed as not working. An individual was considered working if the evidence showed any other employment statues (i.e. newly hired, received a promotion, job jeopardy, or the job security was unknown). A binary logistic regression was applied to determine which functional limitations were linked to job maintenance.
Findings:  The results of this study found that the mean of cases per state was 4.16, but an increase in the number of cases per state occurred in states with higher populations and multiple big cities, including New York, California, Florida, and Texas. The study also found that a total of 408 functional limitations were reported by the 160 survivors. The ranger per person was from one to eight, with a 2.48 mean and standard deviation of 1.49. Memory loss was found to be the most common limitation, with 70 subjects or 44% of the sample reporting this limitation. Memory loss comprised 17% of the limitations reported. Attention/concentration was reported by fifty subjects, or 31% of the concentration, making it the second most common functional limitation. Attention/concentration was 12% of the functional limitations reported.
Conclusions:  The conclusion of this study was that medical symptoms and emotional dysregulation were reliably and inversely connected to job maintenance. Consistent with current research, this study found the most prevalent reported limitation to be attention/concentration. While attention/concentration are the most commonly reported functional limitation by individuals with TBI, this study found that trouble with emotional dysregulation and the presence of medical symptoms may be better indicators of the individual’s ability to keep a job. Limitations of this article were the reliance on self-reporting, insufficient information on the severity of the individual’s TBI, and that demographic factors were not taken into account.

Disabilities served:  Traumatic brain injury (TBI)
Outcomes:  Other