Traumatisme crânien cérébral léger (TCCL)

Septembre 2021

Facilitators of and barriers to return to work after mild traumatic brain injury: A thematic analysis.

Purpose Individuals with mild traumatic brain injury (mTBI) may experience protracted symptoms affecting their ability to work. Several actors may facilitate or act as a barrier to a successful return to work (RTW). Methods This qualitative study used semi-structured in-depth interviews with 22 adults with mTBI at 2-5 years post injury, targeting experiences of how different actors facilitated or acted as a barrier in the RTW process, and encompassed the mTBI trajectory from the acute phase to the post-acute phase. A thematic analysis with a hermeneutical phenomenological approach was used to analyse data. Results Three main themes emerged. (1) Worker-employer relationship: Workplace accommodations such as decreased working hours, modified working conditions, and support from co-workers were lacking. (2) The role of the general practitioner: The general practitioner was lacking treatment and referral opportunities and failed to provide the patient with relevant and individualized guidance. (3) Municipal case management: Participants perceived being met with distrust by social workers, follow-up assessments were too frequent, unnecessary, and did not target concussion, and rehabilitation was referred too late. Conclusion Clinical practice guidelines to improve referral to relevant concussion rehabilitation in case of persistent symptoms are needed to inform clinicians, employers, and public institutions to facilitate a successful RTW.

Source: Graff HJ, Deleu NW, Christiansen P, Rytter HM, Neuropsychological rehabilitation, 2021 Oct; Vol. 31 (9), pp. 1349-1373

The experience of employers of individuals with traumatic brain injury.

Purpose To understand the experience of employers of individuals with traumatic brain injury (TBI) who have received comprehensive vocational rehabilitation (VR), the factors involved in supporting an individual with TBI to return to work (RTW), and the support needs of employers. Methods 12 employers completed semi-structured interviews, which were recorded, transcribed, and analysed thematically. Results Five main themes were identified: challenges and impact on employer, managing employee post-injury changes, looking after employee wellbeing, managing conflicting emotions, and utilizing sources of support. Although employers received support with operational challenges, findings suggest they were not prepared for the emotional journey. While they struggled to support employees through the difficult process of realizing they could no longer perform at their pre-injury level, employers strove to find appropriate roles and ensure wellbeing for their injured employees. Despite employers' endeavours, they felt this process was demoralizing for some employees. Conclusions Advising employers on operational as well as emotional support needs of both employees and employers is an ongoing challenge for VR providers. Although unsupportive employers were not well-represented in this sample, the study highlights the challenges faced and strategies used by employers who have a strong personal investment in the successful RTW of their employees.

Source: Libeson L, Ross P, Downing M, Ponsford J, Neuropsychological rehabilitation, 2021 Aug 30, pp. 1-23

Impact of cognitive and behavioural functioning on vocational outcome following traumatic brain injury: a systematic review.

Purpose Individuals with traumatic brain injury (TBI) often present injury-related cognitive and behavioural sequelae hindering a successful professional outcome, even many years after injury. The aim of this study was to investigate cognitive and behavioural factors predicting vocational outcome in the post-acute stages (≥one year) of TBI. Methods A systematic review of empirical research about vocational outcome of individuals with TBI was conducted. Studies published in PubMed and PsycINFO from 1 January 1998 to 31 May 2019 were screened. Only studies using the same injury severity criteria (the Glasgow Coma Scale score and/or the duration of post-traumatic amnesia) were selected. Results We found that (1) self-reported symptoms, (2) Functional Independence Measure and Mayo-Portland Adaptability Inventory Scores, (3) alcohol abuse and mood disorders, and (4) Differentiated Outcome Scale Cognitive Scores in individuals with TBI were highly predictive of the vocational outcome. Conclusion This systematic review emphasized the link between cognitive and behavioural functioning and vocational rehabilitation in individuals with TBI. However, scientific literature lacks cognitive and behavioural models predicting vocational outcome of these individuals, including academic or vocational training. Such models would allow clinicians to improve vocational guidance of these individuals.Implications for rehabilitationCognitive and behavioural assessment is highly important even many years after traumatic brain injury, especially in a social and professional rehabilitation context.Clinicians should integrate objective measures of cognition and behaviour in post-acute phases of traumatic brain injury.Identifying vocational outcome related cognitive and behavioural patterns of functioning would allow clinicians to improve vocational guidance of adults with traumatic brain injury.

Source: Manoli R, Delecroix H, Daveluy W, Moroni C, Disability and rehabilitation, 2021 Sep; Vol. 43 (18), pp. 2531-2540

Août 2021

Facilitators of and barriers to return to work after mild traumatic brain injury: A thematic analysis.

Purpose Individuals with mild traumatic brain injury (mTBI) may experience protracted symptoms affecting their ability to work. Several actors may facilitate or act as a barrier to a successful return to work (RTW). Methods This qualitative study used semi-structured in-depth interviews with 22 adults with mTBI at 2-5 years post injury, targeting experiences of how different actors facilitated or acted as a barrier in the RTW process, and encompassed the mTBI trajectory from the acute phase to the post-acute phase. A thematic analysis with a hermeneutical phenomenological approach was used to analyse data. Results Three main themes emerged. (1) Worker-employer relationship: Workplace accommodations such as decreased working hours, modified working conditions, and support from co-workers were lacking. (2) The role of the general practitioner: The general practitioner was lacking treatment and referral opportunities and failed to provide the patient with relevant and individualized guidance. (3) Municipal case management: Participants perceived being met with distrust by social workers, follow-up assessments were too frequent, unnecessary, and did not target concussion, and rehabilitation was referred too late. Conclusion Clinical practice guidelines to improve referral to relevant concussion rehabilitation in case of persistent symptoms are needed to inform clinicians, employers, and public institutions to facilitate a successful RTW.

Source: Graff HJ, Deleu NW, Christiansen P, Rytter HM, Neuropsychological rehabilitation, 2021 Oct; Vol. 31 (9), pp. 1349-1373

The experience of employers of individuals with traumatic brain injury.

Purpose To understand the experience of employers of individuals with traumatic brain injury (TBI) who have received comprehensive vocational rehabilitation (VR), the factors involved in supporting an individual with TBI to return to work (RTW), and the support needs of employers. Methods 12 employers completed semi-structured interviews, which were recorded, transcribed, and analysed thematically. Results Five main themes were identified: challenges and impact on employer, managing employee post-injury changes, looking after employee wellbeing, managing conflicting emotions, and utilizing sources of support. Although employers received support with operational challenges, findings suggest they were not prepared for the emotional journey. While they struggled to support employees through the difficult process of realizing they could no longer perform at their pre-injury level, employers strove to find appropriate roles and ensure wellbeing for their injured employees. Despite employers' endeavours, they felt this process was demoralizing for some employees. Conclusions Advising employers on operational as well as emotional support needs of both employees and employers is an ongoing challenge for VR providers. Although unsupportive employers were not well-represented in this sample, the study highlights the challenges faced and strategies used by employers who have a strong personal investment in the successful RTW of their employees.

Source: Libeson L, Ross P, Downing M, Ponsford J, Neuropsychological rehabilitation, 2021 Aug 30, pp. 1-23

Impact of cognitive and behavioural functioning on vocational outcome following traumatic brain injury: a systematic review.

Purpose Individuals with traumatic brain injury (TBI) often present injury-related cognitive and behavioural sequelae hindering a successful professional outcome, even many years after injury. The aim of this study was to investigate cognitive and behavioural factors predicting vocational outcome in the post-acute stages (≥one year) of TBI. Methods A systematic review of empirical research about vocational outcome of individuals with TBI was conducted. Studies published in PubMed and PsycINFO from 1 January 1998 to 31 May 2019 were screened. Only studies using the same injury severity criteria (the Glasgow Coma Scale score and/or the duration of post-traumatic amnesia) were selected. Results We found that (1) self-reported symptoms, (2) Functional Independence Measure and Mayo-Portland Adaptability Inventory Scores, (3) alcohol abuse and mood disorders, and (4) Differentiated Outcome Scale Cognitive Scores in individuals with TBI were highly predictive of the vocational outcome. Conclusion This systematic review emphasized the link between cognitive and behavioural functioning and vocational rehabilitation in individuals with TBI. However, scientific literature lacks cognitive and behavioural models predicting vocational outcome of these individuals, including academic or vocational training. Such models would allow clinicians to improve vocational guidance of these individuals.Implications for rehabilitationCognitive and behavioural assessment is highly important even many years after traumatic brain injury, especially in a social and professional rehabilitation context.Clinicians should integrate objective measures of cognition and behaviour in post-acute phases of traumatic brain injury.Identifying vocational outcome related cognitive and behavioural patterns of functioning would allow clinicians to improve vocational guidance of adults with traumatic brain injury.

Source: Manoli R, Delecroix H, Daveluy W, Moroni C, Disability and rehabilitation, 2021 Sep; Vol. 43 (18), pp. 2531-2540

Juin 2021

Perceived Injustice After Mild Traumatic Brain Injury.

Purpose To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI). Methods Design: Observational study. Setting: TBI outpatient unit. Participants: Adult patients aged 18 to 68 years with mTBI (n = 100) or orthopedic injury ([OI]; n = 34). Main Measures: The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory-Second Edition (BDI-II), PTSD Checklist-Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected. Results Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ (rs = 0.638, P < .01), BDI-II (rs = 0.612, P < .01), PCL-C (rs = 0.679, P < .01), and PVAS (rs = 0.232, P < .05). The association between IEQ and PCL-C (rs =0.797, P < .01) and BDI-II (rs = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance.Conclusions Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.

Source: Mäki K, Nybo T, Hietanen M, Huovinen A, Marinkovic I, Isokuortti H, Melkas S, The Journal of head trauma rehabilitation, 2021 Jun 15

Avril 2021

Traumatic microbleeds in mild traumatic brain injury are not associated with delayed return to work or persisting post-concussion symptoms

Purpose The main objective of this prospective cohort study was to evaluate whether traumatic microbleeds (TMBs) are a significant prognostic factor of return to work (RTW), post-traumatic symptoms and overall recovery in patients with mild traumatic brain injury (MTBI). Methods One hundred and thirteen (n=113) patients with MTBI were recruited from the Helsinki University Hospital emergency units. All patients underwent multicontrast 3T MRI imaging 3-17 days after MTBI. Patients were evaluated in the Traumatic Brain Injury Outpatient Clinic of Helsinki University Hospital one month after injury. Post-concussion symptoms were assessed with Post-Concussion Symptom Questionnaire (RPQ) and overall recovery with Glasgow Outcome Scale Extended (GOS-E). Their time to RTW was continuously measured up to one year after MTBI. Results Median RTW was 9 days (IQR 4 - 30) after MTBI and full RTW rate after one year was 98%. Patients with TMBs (n=22) did not have more post-concussion symptoms (median RPQ 10.0 vs. 7.0, p=0.217) or worse overall recovery (58% vs. 56% with GOS-E = 8, p=0.853) compared to patients without TMBs (n=91). There was no significant difference in time to RTW (13.5 vs. 7.0 days, p=0.063). Conclusions In this study, patients with TMBs did not have delayed RTW nor more post-concussion symptoms compared to other patients with MTBI. TMBs in MTBI do not seem to be a significant prognostic factor of RTW.

Source: Huovinen A, Marinkovic I, Isokuortti H, Korvenoja A, Mäki K, Nybo T, Raj R, Melkas S, Journal of neurotrauma, 2021 Apr 13

Mars 2021

Returning to work or working on one's rehabilitation: Social identities invoked by impaired workers and professionals in health care and employment services

Purpose For persons with a long-term illness or impairment, return-to-work decisions involve considerations about work capacity, opportunities in the labour market, the impact of injuries, further treatment requirements, physical and cognitive rehabilitation, and mental health recovery. These considerations are undertaken by the affected individuals as well as by professionals in health care and employment services. Methods Drawing upon institutional theories of organisations, especially the understanding that institutional logics provide different social identities to injured individuals, we study rehabilitation processes following multi-trauma or traumatic brain injury (TBI) within the Scandinavian welfare model. We identify which social identities are activated in professionals' considerations and in the stories of the injured individuals. The aim is to understand how professionals' reasoning about the clients' problems influences return-to-work processes. Results Our primary finding is that the wageworker identity, invoked by the injured individuals themselves, is subordinated by the professionals to the logic of profession and the associated patient identity. Consequently, not only is impaired people's anti-discrimination right to reasonably adjusted work ignored, ignored is also a possible resource in the rehabilitation process. Additionally, individuals who view themselves as wageworkers tend to be left unserved.

Source: Andreassen TA, Solvang PK, Sociology of health & illness, 2021 Feb 26

Février 2021

Designing an intervention process that embeds work-focussed interventions within inpatient rehabilitation: An intervention mapping approach

Purpose Returning to work is a goal for many people after brain injury. The failure to return to work after injury brings both economic and personal (quality of life) costs to those living with stroke or brain injury, their families, and society. This study explored the barriers to providing work-focused interventions during hospital-based rehabilitation and co-created solutions with rehabilitation providers to increase the provision of work-focused intervention during inpatient rehabilitation. Methods This study used an Intervention Mapping approach (a six-step protocol that guides the design of complex interventions) based on an action research methodology. Focus group data, in addition to best evidence from systematic reviews, practice guidelines and key articles were combined with theoretical models for changing behaviour and clinician experience. This was then systematically operationalised into an intervention process using consensus among clinicians. The process was further refined through piloting and feedback from key stakeholders, and group consensus on the final process. Results A detailed five phase return to work intervention process for inpatient rehabilitation was developed. The key features of the process include; having one key allied health clinician to coordinate the process, choosing assessments based on pre-injury work demands, emphasising the importance of core work skills and considering the most appropriate service for referral at the conclusion of rehabilitation. Conclusion We used a systematic approach, guided by the intervention mapping approach and behaviour change theory to tailor existing workfocused interventions to the inpatient setting.

Source: O'Keefe S, Stanley M, Sansonetti D, Schneider EJ, Kras M, Morarty J, Lannin NA, Australian occupational therapy journal, 2021 Feb; Vol. 68 (1), pp. 65-77