Logo for the Journal of Rehab R and D

Volume 46 Number 6, 2009
   Pages 893 — 908

Abstract — Minimizing the effect of TBI-related physical sequelae on vocational return

Shane McNamee, MD;1-2* William Walker, MD;2 David X. Cifu, MD;1-2 Paul H. Wehman, PhD2

1Department of Physical Medicine and Rehabilitation, Hunter Holmes McGuire Richmond Department of Veterans Affairs Medical Center, Richmond, VA; 2Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA

Abstract — This article evaluated the common physical sequelae that affect return to work (RTW) after traumatic brain injury (TBI). We performed a Medline search and evaluation of current TBI rehabilitation texts. The information presented is a combination of published literature and clinical guidelines. The limitations faced by many patients with TBI can best be overcome through clever job search, job redesign, and community linkages with business and industry that are willing to partner in helping the patient with TBI regain employment. The physician plays a key role in communicating suggestions to the vocational specialist. The comorbidities described represent challenges to successful RTW. These problems are recurrent, long-term, and clearly affect job procurement, nature of job, level of required support, and likelihood of job retention. Conversely, these challenges should not be viewed as impenetrable obstacles. With appropriate supports such as compensatory strategies, job coaching, assistive technology, medical management, and job restructuring, successful RTW is viable option. Physicians must focus on employment outcomes in real jobs and not settle for volunteer work, sheltered work, or assessment and planning. Individuals should be placed in real work for real pay. Through close collaboration between the survivor of TBI, the physician, the vocational specialist, and community resources, successful employment for survivors of TBI is possible and must be prescribed a high value.

Key words: community reintegration, employment, functional restoration, rehabilitation, return to work, school reintegration, TBI, traumatic brain injury, vocational return, work reintegration.

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