Stability of employment after brain injury: a 7-year follow-up study.

Forty-three patients with severe traumatic brain injury (n = 24), cerebrovascular diseases (n = 15), or other acquired brain damage (n = 4) were followed-up 7-8 years after neuropsychological rehabilitation including a vocational re-entry programme. Current vocational status and work history since rehabilitation were investigated by means of a structured interview. Before interview, the patients were classified on the basis of medical records into four groups: (A) patients with minor residual neuropsychological impairments, (B) patients with minor impairments but psychopathological symptoms, (C) patients with persistent neuropsychological impairments showing no psychopathological symptoms, and (D) patients with persistent impairments and psychopathological symptoms. For patients in group A, a good, and for those in group D, a poor long-term employment outcome was predicted, while no predictions were made for the intermediate groups. Of the 43 interviewed subjects, 16 (37%) reported a stable return to work at pre-morbid level and seven (16%) at a lower level. In eight patients (19%), persisting difficulties in maintaining work were documented. Twelve subjects (28%) had retired within a period of 2 years after work trial. The relationship between patient classification and long-term employment outcome was only weak. Four out of 11 patients with a good prognosis (group A) experienced vocational adjustment problems or had retired. Three out of 10 patients with a poor prognosis (group D) were able to continue successfully with their previous jobs. These cases are described in detail. The employment outcome of the intermediate groups was very heterogeneous. The results suggest that particular attention should be paid to the long-term consequences of a reduced capacity for work, even if minor in degree. The success of patients despite a poor prognosis illustrate unsolved problems in relation to the ecological validity of neuropsychological measures of executive dysfunctions.