Cognitive, Emotional, and Physical Functioning as Predictors of Paid Employment in People With Stroke, Traumatic Brain Injury, and Spinal Cord Injury

American Journal of Occupational Therapy, 2019 · DOI: https://doi.org/10.5014/ajot.2019.031203 · Published: March 1, 2019

Occupational Health Neurorehabilitation Rehabilitation

Simple Explanation

This study looked at factors that help people with neurological injuries return to paid work. These injuries included stroke, traumatic brain injury (TBI), and spinal cord injury (SCI). Researchers wanted to know what physical, emotional, and cognitive abilities were most important for returning to employment. The study found that cognitive skills, especially the ability to sequence tasks and control impulses, were strong predictors of employment. Being married or partnered and having more education also increased the chances of being employed after a neurological injury. The findings suggest that rehabilitation should focus on improving cognitive strategies to help people with neurological injuries return to work. This includes training to improve planning, self-regulation, and the ability to handle complex tasks.

Study Duration

Not specified

Participants

480 adults with stroke, traumatic brain injury, and spinal cord injury

Evidence Level

Not specified

Key Findings

1
Executive functioning, specifically sequencing and inhibitory control, strongly predicts employment after neurological injury.
2
Being married or partnered and having a college education were significant predictors of employment.
3
Participants who returned to work within 3 months of injury were more likely to work with the same employer and hold a full-time position.

Research Summary

The study examined demographic, cognitive, emotional, and physical factors predicting return to paid employment after neurological injury (stroke, TBI, SCI). Executive functions like sequencing and inhibitory control are significant predictors of employment, emphasizing the need for cognitive strategy training in occupational therapy. Married/partnered status and higher education levels also significantly predicted employment, while early return-to-work (within 3 months) correlated with retaining the previous employer and full-time positions.

Practical Implications

Cognitive Rehabilitation Focus

Emphasize cognitive strategy training, particularly in sequencing and inhibitory control, during occupational therapy for individuals with neurological injuries to enhance employment prospects.

Early Intervention Programs

Implement early return-to-work rehabilitation programs to facilitate quicker re-entry into the workforce, ideally within the first 3 months post-injury, to increase the likelihood of retaining the previous employer and securing full-time employment.

Address Executive Function

Integrate interventions targeting executive function, such as problem-solving and self-regulation skills, to improve employment outcomes, considering both cognitive restoration therapies and environmental support strategies.

Study Limitations

1
Cross-sectional study design limits causal inferences between physical, emotional, cognitive functions, and work functioning.
2
The study did not examine how employment changes over time or whether predictors change with time since injury.
3
Self-reported measures were used to assess work status and physical functioning, potentially introducing bias.

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