title: Neuropsychological impairments, vocational outcomes, and financial costs for individuals with traumatic brain injury receiving state vocational rehabilitation services.
abstract: OBJECTIVE
  To determine the relationship among neuropsychological variables, vocational outcomes, and vocational costs for Missouri Division of Vocational Rehabilitation (MO-DVR) clients with traumatic brain injury (TBI).
  
  
  METHODS
  Clients referred for neuropsychological evaluations were followed until DVR case closure. Subjects were grouped according to the following DVR status at case closure: Successfully Employed, Services Interrupted, and No Services Provided. Spearman correlations with Bonferroni corrections were calculated to determine relationships among variables, and Kruskal-Wallis nonparametric one-way analyses of variance (ANOVAs) were conducted to evaluate differences in DVR group status in terms of neuropsychological variables and DVR costs.
  
  
  METHODS
  All evaluations were completed through a Midwestern university neuropsychology laboratory.
  
  
  METHODS
  110 consecutively referred DVR clients with nonacute TBI referred for neuropsychological evaluation.
  
  
  METHODS
  Absolute level (ie, raw/standard scores) of neuropsychological functioning and relative degree of decline in: intelligence (WAIS-R), memory (WMS-R General and Delayed Memory Indices), attention (WMS-R Attention Index), speed of processing (Trails A), and cognitive flexibility (Trails B); DVR costs at closure.
  
  
  RESULTS
  1) Surprisingly, the Successfully Employed group had significantly greater neuropsychological impairments; 2) Greater decline in delayed memory was associated with higher DVR costs (r = -0.30, P <.05); and 3) More indices of relative decline were significantly correlated with vocational outcomes (5/6) than were indices of absolute functioning (3/6).
  
  
  CONCLUSIONS
  DVR is effective in providing services to individuals with the most significant neuropsychological deficits; it is important to consider both absolute level of functioning and relative decline in functioning when evaluating TBI.
authors.affiliation: Department of Physical Medicine and Rehabilitation, School of Medicine, University of Missouri-Columbia 65212, USA.
authors.forename: B
authors.initials: B
authors.lastname: Johnstone
authors.forename: L H
authors.initials: LH
authors.lastname: Schopp
authors.forename: J
authors.initials: J
authors.lastname: Harper
authors.forename: J
authors.initials: J
authors.lastname: Koscuilek
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001930:Brain Injuries / Q000150:complications / Q000191:economics / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000175:diagnosis* / Q000191:economics / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D009483:Neuropsychological Tests / Q000592:standards; D010347:Patient Care Planning / Q000191:economics; D011379:Prognosis; D017150:Public Sector / Q000191:economics; D012016:Reference Values; D012050:Rehabilitation, Vocational / Q000191:economics / Q000379:methods; D016896:Treatment Outcome