Neurologische Berufstherapie : Evaluation kognitiver Leistungsdaten und beruflicher Wiedereingliederungsverläufe bei neurologischen Patienten

Abstract

The vocational rehabilitation of neurological patients with cognitive disabilities is often difficult, even with those patients, whose deficits do not seem to be too severe.By developing a specific rehabilitation program that prepares patients for their return to work within a clinical treatment setting the patients chances to reintegrate vocationally should be improved.In order to find out how successful these job-related therapeutic interventions are, how cognitive disabilities interfere, how long return to work takes und to which extent a successful reintegration depends on the occupational status, neuropsychological and outcome data of patients who received a vocational therapy were evaluated.Patients, whose place of work was preserved when starting the vocational therapy and who showed cognitive disorders according to a neuropsychological test battery in at least one attention-, memory- or intelligence subtest, were prepared individually for their return to work.By comparing the special job requirements of each patient to the profile of his or her neuropsychological deficits job-related cognitive abilities, e.g. number processing or text comprehension, were trained. Specific (knowledge) resources, e.g. to handle a professional computer program, were proved. Compensatory means and adaptive strategies were developed prospectively to be used at one s individual place of work.At the end of this vocational therapy patients were recommended how to start their return to work. Those patients who were recommended to start a stepwise work trial at their former place of work received written recommendations concerning the daily working time they should start with and how to increase this time step by step. On the task level these patients were also recommended with which (sub)task under which working conditions they should start their work trial.The outcome of those patients who were recommended to reintegrate to their former place of work was evaluated about 12 months after discharge.Out of 107 patients (52 female; age median: 47; 65 patients with cerebrovascular etiology; median time post onset: 8 months) 79 patients were recommended to return to work mostly by starting a graded work trial. The majority of these patients followed this recommendation and most of them were successful in returning stepwise to their former place of work. 58 patients managed to restart work.Only one of those 28 patients who were not recommended to return to work because of insufficient recovery managed to regain his former work place.By comparing cognitive test data of the 59 patients whose vocational reintegration was successful to the data of the 48 patients who did not manage to return to their former place of work significant differences in various subtests were found: the successful subgroup performed better.A discriminant analysis showed that a few attention and memory tests discriminated best between the two subgroups (70 % correct re-classification with crossvalidated cases).The outcome of vocational reintegration was not influenced by age and etiology, but some gender and education effects were observed:Female patients were less successful concerning their vocational reintegration though their cognitive performance was higher than that of the male subgroup.The patients with the lowest degree of education (8-9 years of schooling) were less successful too, but the comparison of their cognitive test data to those of the better educated subgroups revealed poorer results in the less educated subgroup.The temporal distribution of vocational reintegration indicated that about one third of the successful reintegrated patients returned to work already between 6 and 8 months post onset, while another third needed more time: about 18 months post onset.The occupational status of patients was described by formation (different types of schooling vs. university degree) and different job requirements (mainly physical vs. mainly cognitive/ socio-communicative vs. mainly cognitive / technical). Analyzing the distribution of successful and unsuccessful vocational rehabilitation on these occupational groups no clear effect was found.Differences of cognitive performance as well as gender, education and some time post onset aspects may support the prediction of vocational outcome in brain-damaged patients. But these prediction variables will not be sufficient on the single case level. By analyzing the individual professional requirements, deficits and resources, by developing job-specific trainings and by planning suitable steps of reintegration a patient´s return to work can be supported more efficiently.