The relationship of cognitive retraining to neurological patients' work and school status.

PRIMARY OBJECTIVE: To explore the relationship of cognitive retraining performance to discharge productivity status. METHODS AND PROCEDURES: One hundred and one brain-injured patients from a holistic milieu-oriented work/school re-entry programme. EXPERIMENTAL INTERVENTIONS: Initial, last, mean and best cognitive retraining scores; cognitive retraining behavioural checklist ratings; and working alliance scores. MAIN OUTCOMES AND RESULTS: Most (82.2%) of the sample returned to paid work or school. Better performance on two cognitive retraining tasks addressing information processing speed, visual scanning, visuospatial skills and memory were associated with return to the same level of work/school with and without modifications. Selected process variables related to the patients' behavioural approach to cognitive retraining tasks (e.g. their use of compensations, organizational and abstraction skills, procedural skills and unassisted task recall) were associated with better work/school outcomes. Patients' positive working alliance ratings related to their behavioural approach to cognitive retraining tasks. This highlights the importance of combining interventions targeting both the therapeutic interactive process and skill remediation to maximize work/school reintegration. CONCLUSIONS: Cognitive Retraining exercises that incorporate both process variables and metacognitive skills, as well as a better working alliance with patients, positively related to return to work and school at the time of discharge from a holistic milieu-oriented programme.

Psychosocial outcomes 1-7 years after comprehensive milieu-oriented neurorehabilitation: the role of pre-injury status.

PRIMARY OBJECTIVE: To explore pre-injury variables related to post-discharge psychosocial status and identify factors related to work and driving outcomes. METHODS AND PROCEDURES: Ninety-three brain-injured patients attended a holistic milieu-oriented neurorehabilitation program and were contacted 1-7 years post-discharge. EXPERIMENTAL INTERVENTIONS: Questionnaire data addressing pre-injury and post-injury work, driving, income, marital status and living situation. MAIN OUTCOMES AND RESULTS: 74.3% were involved in competitive work and/or school with 86.0% productive at follow-up. Post-injury income decreased significantly compared with pre-injury levels. Pre-injury relationship status did not differ significantly from post-injury; 81.1% remaining in a stable relationship or married at follow-up. Pre-injury and post-injury accident rates were related; 73.1% drove at follow-up. Higher education, non-right hemispheric injury, shorter treatment length and return to work related to driving. Younger age, higher education, non-right hemispheric injury and driving post-injury related to positive work status. CONCLUSIONS: Pre-injury psychosocial data provide an important context for understanding post-discharge outcome after brain injury. Holistic milieu-oriented rehabilitation facilitates long-term successful work, driving and relationship stability.