Monthly Archives: July 2010
Return to work: Is the workplace ready for the TBI survivor?
Occupational therapists work one-on-one with people after a traumatic brain injury in order to recover as much of a pre-injury daily life as possible. Return to work, with its financial, social, and psychological advantages, is one important goal in occupational therapy. However, assessing a patient for the ability to return to work can be challenging—factors such as pre-injury job duties, personality changes, disability, limited self-awareness, or employer understanding can all complicate the issue.
A recent study rated the issues that were most relevant in the decision to return to work. The personal attributes most important to success in the return to work were not especially surprising:
- Motivation
- Functional and physical independence
- Cognitive abilities
- Use of compensatory strategies and feedback
What made this study different, however, was that they addressed the employer’s readiness to provide a safe, sensitive, and financially feasible workplace for the TBI survivor. They found the most relevant workplace environment factors to be the following:
- Workplace demands (safety, risk assessment)
- Employer resources and resulting burden (time, money)
- Risks with information sharing (communication, confidentiality)
- Financial impacts of Return To Work (litigation outcome, cost of therapy, disability benefits)
Stergiou-Kita M, Yantzi A, & Wan J. The personal and workplace factors relevant to work readiness evaluation following acquired brain injury: Occupational therapists’ perceptions. Brain Injury. (July 2010.)
Late recovery of responsiveness and consciousness not the exception after vegetative state
It has been considered unlikely that a person in a vegetative state will regain consciousness beyond 12 months after a traumatic brain injury or 3 months after an anoxic or hemorrhagic injury.
However, ongoing improvements in both research methodology and medical intervention may be changing this way of thinking. A recent study of long-term vegetative state patients showed that 20% recovered responsiveness after 12 months, and 12% of those further progressed to regain consciousness. This recovery was associated strongly with younger age and occurred more often in traumatic brain injury, rather than anoxic or hemorrhagic.
Unfortunately, although responsiveness and consciousness can be recovered in some cases of vegetative state, it is also associated with severe functional impairments. Still, that the recovery rates were unexpectedly high in this study is an issue with ethical implications that should be addressed by medical and legal professionals.
Estraneo A, Moretta P, Loreto V, et al. Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology. (July 2010).
The role of the pediatrician in mTBI
Children who suffer from mild traumatic brain injury are often referred back to their primary pediatrician for follow-up care. A recent study found that 89% of pediatricians felt that they were the appropriate care provider for the follow-up of mTBI, however 59% of these did not participate in continuing education to learn more about TBI and 62% did not administer neuropsychological tests.
Recent research has advanced our understanding of mTBI—so much so that health care providers need to be aware of changing guidelines and recommendations. The CDC has published a toolkit for physicians who treat mTBI, but many primary care physicians may still be unaware of it. The tool kit can be found at http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html.
The follow-up of mTBI is especially important in children, for whom complex decisions, such as return to sport, need to be carefully considered. Pediatricians who treat mTBI in their practice need to be aware of the current guidelines set out by the CDC.
Kaye AJ, Gallagher R, Callahan, JM, & Nance ML. Mild traumatic brain injury in the pediatric population: The role of the pediatrician in routine follow-up. Journal of Trauma Injury, Infection, and Critical Care. (June 2010).
Appropriations Update
On Thursday, July 1, 2010, the House adopted a one-year spending (H. Res. 1493) plan instead of a traditional five-year budget resolution, which has stalled because of intraparty differences over spending levels and concern over budget deficits.
The plan, which Democrats call a “budget enforcement resolution” for fiscal 2011, would set a limit of $1.121 trillion on discretionary spending. Democrats say it would allow about $7 billion less to be spent in fiscal 2011 than President Obama requested.
The Senate Budget Committee approved a full fiscal 2011 budget resolution (S. Con. Res. 60) on April 22, 2010 that called for $4 billion less in discretionary spending next year than President Obama requested. The full Senate has not taken up that measure and is not expected to since the House will not move a similar plan. (CQ)
BIAA will continue to advocate for increased funding for programs authorized through the TBI Act as well as for NIDRR’s Model Systems of Care program even in this tough appropriations climate. We will alert grassroots advocates if action is needed.
