Verbal reasoning, cognitive-communication skills and return to work - - PowerPoint PPT Presentation

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Verbal reasoning, cognitive-communication skills and return to work - - PowerPoint PPT Presentation

Nov 17, 2022 129 likes •302 views

Verbal reasoning, cognitive-communication skills and return to work outcomes in adults with severe Traumatic Brain Injury at two years post- injury Presented by Lai Teng Cheah Supervisors | Belinda Kenny, Emma Power & Leanne Togher

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Verbal reasoning, cognitive-communication skills and return to work

  • utcomes in adults with

severe Traumatic Brain Injury at two years post- injury

Presented by Lai Teng Cheah Supervisors | Belinda Kenny, Emma Power & Leanne Togher

Faculty of Health Sciences | Discipline

  • f Speech Pathology
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Traumatic Brain Injury (TBI)

Results in diffuse damage to the brain 1 May lead to cognitive-communication skills causing difficulties with verbal reasoning2 E.g. Inflexibility in generating solutions Causes long-term poor psychosocial outcomes 3 32% to 46% of adults with TBI return to work at 2 years post-injury 4 Vocational rehabilitation is a central goal Participation Impacted by functional communication difficulties 5, 6, 7

  • 1. Background

and Rationale

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Research questions

  • 1. In adults with severe TBI at two years post-

injury, do cognitive-communication and verbal reasoning skills differ between employment groups?

  • 2. In adults with severe TBI at two years post-

injury, are there significant differences in demographic and injury-related characteristics between employment groups?

  • 2. Questions
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Design & Methodological approach Observational cross-sectional multi-site study

  • 3. Design and

Methods

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FAVRES Task Description

  • 1. Planning an event

Analyse newspaper listings to choose an appropriate event for a child’s birthday

  • 2. Scheduling

Organise daily activities according to priorities and time constraints

  • 3. Making a Decision

Choose an appropriate gift based on information from a conversation

  • 4. Building a case

Write a complaint with solutions based on issue raised in a monologue Scores

  • 1. Accuracy
  • 2. Rationale
  • 3. Time
  • 4. Reasoning

Correct choice of response Reasons provided for choice of answer Length of time to complete task (minutes) Assesses reasoning and problem solving process

Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES)

  • 3. Design and

Methods

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Return to Work (RTW) outcome

Employed: at preinjury level based on occupation title and workload Employed with modification: reduced responsibilities and/or time fraction. Unemployed: not working or on leave

  • 3. Design and

Methods

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Procedure

Aged 16 to 65 years old Sustained a severe TBI defined as

  • Global Coma Scale (GCS) ≤ 8 and/or
  • Post Traumatic Amnesia (PTA) > 7 days

Employed preinjury

Participants recruited from 3 brain injury units Assessments at 2 year post-injury

  • Self-reported employment variables
  • Functional Assessment of Verbal Reasoning and Executive Strategies

(FAVRES)

  • 4. Procedure

and Analysis

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Analysis

Descriptive statistics Between-group analyses using non-parametric tests An alpha level of 0.05 was applied

  • 4. Procedure

and Analysis

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Occupation characteristics

4 5 6 10 1 5 1 2 4

2 4 6 8 10 12

STUDENTS/ HOMEMAKERS MANAGERS PROFESSIONALS TECHNICIANS AND TRADES COMMUNITY AND PERSONAL … CLERICAL AND ADMINISTRATIVE SALES MACHINERY OPERATORS AND … LABOURERS

OCCUPATION CATEGORIES

Australian and New Zealand Standard Classification of Occupations (ANZSCO) 8

5 13 16 4 2 4 6 8 10 12 14 16 18 Job Zone 1 and 2 Job Zone 3 Job Zone 4 and 5 Others

JOB ZONE

US Department of Labour’s five-tiered categorization system 9

  • 5. Findings

Participants’ jobs require higher degree of training and communication demands.

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Descriptive statistics

Cognitive-communication impairments and poor RTW

  • utcomes continue to persist in adults with severe TBI at two

years post-injury

  • 5. Findings

34.2% 36.8% 29.0%

Return to work (RTW) outcomes

Unemployed Employed with modification Employed

84% 16%

FAVRES Cut-off Score

Below cut

  • ff

Above cut off

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FAVRES Total Scores

  • 5. Findings

FAVRES Total Accuracy and Total Reasoning scores significantly discriminated between groups.

FAVRES Total Scores E, EM and UE Accuracy Rationale Time Reasoning

Employed (E) Employed with modification (EM) Unemployed (UE)

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FAVRES Total Scores

  • 5. Findings

Stronger verbal reasoning and cognitive-communication skills seem to contribute to better RTW outcomes.

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FAVRES Total Scores

  • 5. Findings

Employed (E) Employed with modification (EM) Unemployed (UE)

Those employed with modification (EM) continue to have cognitive-communication deficits similar to those unemployed (UE).

FAVRES Total Scores E and EM EM and UE E and UE Accuracy Reasoning

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Demographic and injury characteristics

Less severe injury ↓ Post Traumatic Amnesia

  • 5. Findings

Employed (E) Employed with modification (EM) Unemployed (UE)

A complexity of pre- and post-injury characteristics contributing to success in the workplace. Employed Higher educational level ↑ Years of education

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Clinical Implications

Functional communication skills is associated with positive employment outcomes Some adults with TBI who are working with modification continue to have poor cognitive-communication skills

  • 6. Significance

and Implications

Speech pathologists should have continued involvement in the rehabilitation process in the post-acute stages of recovery The FAVRES may help clinicians to identify rehabilitation goals to support one’s vocational reintegration.

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References

  • 1. Menon, D. K., Schwab, K., Wright, D. W., & Maas, A. I. (2010). Position statement: definition of

traumatic brain injury. Archives of physical medicine and rehabilitation, 91(11), 1637-1640.

  • 2. Togher, L., & Code, C. (2014). Social and Communication Disorders Following Traumatic Brain

Injury (Vol. 2nd). Hoboken: Taylor and Francis.

  • 3. Corrigan, J. D., Cuthbert, J. P., Harrison-Felix, C., Whiteneck, G. G., Bell, J. M., Miller, A. C., . . .

Pretz, C. R. (2014). US population estimates of health and social outcomes 5 years after rehabilitation for traumatic brain injury. The Journal of head trauma rehabilitation, 29(6), E1-E9.

  • 4. McRae, P., Simpson, G., Strettles, B., Kent, G., Hallab, L., & Mair, S. (2013). Investigation of

Vocational Programs and Outcomes for People with Traumatic Brain Injury in NSW NSW Agency for Clinical Innovation.

  • 5. Turkstra, L., & Isaki, E. (2000). Communication abilities and work re-entry following traumatic

brain injury. Brain injury, 14(5), 441-453. doi: 10.1080/026990500120547

  • 6. Rietdijk, R., Simpson, G., Togher, L., Power, E., & Gillett, L. (2013). An exploratory prospective

study of the association between communication skills and employment outcomes after severe traumatic brain injury. Brain injury, 27(7-8), 812-818. doi: 10.3109/02699052.2013.775491

  • 7. Meulenbroek, P., & Turkstra, L. (2016). Job stability in skilled work and communication ability

after moderate-severe traumatic brain injury. Disability and rehabilitation, 38(5), 452-410. doi: 10.3109/09638288.2015.1044621

  • 8. Pink, B., & Bascand, G. (2009). ANZSCO-Australian and New Zealand Standard Classification
  • f Occupations (Revision 1). Canberra: Australian Bureau of Statistics.
  • 9. National Center for O*NET Development. O*NET OnLine Help Job Zones. 2010. Available from:

https://www.onetonline.org/help/online/zones [last accessed 05 Sep 2017].