Article Details

Research Database: Article Details

Citation:  Klonoff,P.,S., Talley,M.,C., Dawson, L.K., Myles, S.M., Watt, L.M., Gehrels, J.& Henderson, S.,W. (2007). The relationship of cognitive retraining to neurological patients’ work and school status. Brain Injury, 21 (11), 1097-1107.
Title:  The relationship of cognitive retraining to neurological patients’ work and school status
Authors:  Klonoff,P.,S., Talley,M.,C., Dawson, L.K., Myles, S.M., Watt, L.M., Gehrels, J.& Henderson, S.,W.
Year:  2007
Journal/Publication:  Brain Injury
Publisher:  Informa Healthcare
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  No

Structured abstract:

Background:  The goals of cognitive retraining are to help patients: ameliorate difficulties in cognitive functioning, develop ways to compensate for those problems and improve their awareness and appreciation of how neurobehavioural strengths and difficulties impact and generalize to the home and community. Cognitive training has been viewed as a holistic milieu-oriented approach for people with brain injuries. However, there is considerable scepticism about the benefits of this approach from both healthcare workers and insurance companies. High quality research is needed to on how the effectiveness of cognitive retraining.
Purpose:  The purpose of the study was to explore the relationship of cognitive retraining performance to discharge productivity status. The hypotheses were: 1)Work/school status at discharge will be related to Working Alliance ratings, Cognitive Retraining scores and CRBC ratings; 2) Better Working Alliance scores will be associated with better scores on the CRBC with regard to Use of Compensatory Strategies, Seeing the Big Picture and Independence in Scoring and Record Keeping
Setting:  The study took place in a neurorehabilitation therapy department in a large healthcare center located in Arizona.
Study sample:  The study examined scores on Cognitive Retraining tasks and variables associated with those task and return to work or school outcomes for 101 patients who had participated in neurotherapies at a large medical center in Arizona within a seven year time span. This included patients who had participated in either or both the Work or School Re-entry programmes and by the time of discharge had completed 4 study Cognitive Retraining tasks. The majority of participants were male (63%). The mean age of participants was 35 years with an average of 14 years of education. Around 64% had sustained traumatic brain injury, 22% had cerebrovascular accident and the remaining 14% had other causes of brain injury. Around 59% of the sample had Glasgow Coma Scale data. The majority or 71% had severe brain injuries. The majority or 86% of the participants had a primary goal of return to work and the remaining had the goal of return to school. Among those with the return to work goal the majority or 71% had been in both the Work Re-entry and Home Independence programmes. Of those who planned to return to school, the majority or 79% attended the School Re-entry and Home Independence programmes.
Intervention:  The intervention included several types of combination of programmes designed to assist individuals with returning to work or school post brain injury and/or improve independent living.
Data collection and analysis:  Cognitive retraining data was taken from participants' Cognitive Retraining charts. More specific, this included: inital, last, best adn mean scores for each of the four study tasks. Data on process variables associated with the tasks came from the Cognitive Retraining Behaviour Checklist completed by the person's primary therapist. Scores on Working Alliance came from patient charts. Information on participant's employment and/or shool status also came from the chart.
Findings:  The majority or (82.2%) of the sample returned to paid work or school. Better performance on two cognitive retraining tasks related to information processing speed, visual scanning, visuospatial skills and memory were associated with return to the same level of work/school with and without modifications. Selected process variables related to the patients’ behavioural approach to cognitive retraining tasks were associated with better work/school outcomes. Positive working alliance ratings related to their behavioural approach to cognitive retraining tasks.
Conclusions:  The information provided should help clinicians fine-tune Cognitive Retraining interventions to help patients achieve their maximal level of functioning.

Disabilities served:  Traumatic brain injury (TBI)
Populations served:  Gender: Female and Male
Interventions:  Compensatory strategies
Outcomes:  Employment acquisition
Return to work