Neuropsychological impairments, vocational outcomes, and financial costs for individuals with traumatic brain injury receiving state vocational rehabilitation services.
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.
Johnstone
B
B
Department of Physical Medicine and Rehabilitation, School of Medicine, University of Missouri-Columbia 65212, USA.
Schopp
L H
LH
Harper
J
J
Koscuilek
J
J
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