Traumatic Brain Injury

  • Robyn L. TateEmail author
  • Grahame K. Simpson
  • Philippa McRae
Part of the Handbooks in Health, Work, and Disability book series (SHHDW)


Traumatic brain injury (TBI) is the leading cause of disability in previously healthy young adults. As a consequence, the resumption of work roles can be a difficult and protracted process, particularly for those people with neurocognitive impairments, which may compromise work performance. The introductory sections of this chapter provide an overview of the epidemiology, neuropathology and clinical profiles of TBI, with particular reference to common neuropsychological impairments and their functional consequences. Brief review is made of outcome studies of return to work after TBI and evidence for the effectiveness of a range of vocational rehabilitation programmes, including case management, supported employment and centre-based programmes. The final section of the chapter is devoted to a detailed description of the state of the field of vocational rehabilitation in TBI. The assessment process is described (including the seven-step process of Stergiou-Kita et al. 2011): work preparation, work placement (from the perspective of both the pre-injury and the post-injury employer) and post-placement support. The chapter concludes with a brief section on alternatives to mainstream, competitive employment for those people whose impairments preclude them from returning to work.


Traumatic Brain Injury Severe Traumatic Brain Injury Vocational Rehabilitation Mild Traumatic Brain Injury Neurocognitive Impairment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wagner AK, Hammond FM, Sasser HC, Wiercisiewski D. Return to productive activity after traumatic brain injury: relationship with measures of disability, handicap, and community integration. Arch Phys Med Rehabil. 2002;83(1):107–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Wehman P, Targett P, West M, Kregel J. Productive work and employment for persons with traumatic brain injury: what have we learned after 20 years? J Head Trauma Rehabil. 2005;20(2):115–27.PubMedCrossRefGoogle Scholar
  3. 3.
    van Velzen JM, van Bennekom CAM, Edelaar MJA, Sluiter JK, Frings-Dresen MHW. How many people return to work after acquired brain injury? A systematic review. Brain Inj. 2009;23(6):473–88.PubMedCrossRefGoogle Scholar
  4. 4.
    Lefrancois GR. The lifespan. 4th ed. Belmont: Wadsworth Publishing; 1993.Google Scholar
  5. 5.
    Access Economics. The economic cost of spinal cord injury and traumatic brain injury in Australia. Melbourne: Victorian Neurotrauma Institute; 2008.Google Scholar
  6. 6.
    World Health Organization. International classification of functioning, disability and health. Geneva: World Health Organization; 2001.Google Scholar
  7. 7.
    Thurman DJ, Alverson C, Dunn KA, Guerrero J, Snieze JE. Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil. 1999;14(6):602–15.PubMedCrossRefGoogle Scholar
  8. 8.
    Kraus JF, Black MA, Hessol N, Ley P, Rokaw W, Sullivan C, Bowers S, Knowlton S, Marshall L. The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol. 1984;119(2):186–201.PubMedGoogle Scholar
  9. 9.
    Galarneau MR, Woodruff SI, Dye JL, Mohrle CR, Wade AL. Traumatic brain injury during operation Iraqi freedom: findings from the United States navy-marine corps combat trauma registry. J Neurosurg. 2008;108:950–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien). 2006;148:255–68.CrossRefGoogle Scholar
  11. 11.
    Kraus JF, McArthur DL. Epidemiologic aspects of brain injury. Neurol Clin. 1996;14(2):435–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Fortune N, Wen X. The definition, incidence and prevalence of acquired brain injury in Australia. Canberra: Australian Institute of Health and Welfare; 1999.Google Scholar
  13. 13.
    Tate RL, McDonald S, Lulham JM. Incidence of hospital-treated traumatic brain injury in an Australian community. Aust NZ J Public Health. 1998;22:419–23.CrossRefGoogle Scholar
  14. 14.
    Baguley IJ, Nott MT, Howie AA, Simpson GK, Browne S, King AC, Cotter RE, Hodgkinson A. Late mortality after severe traumatic brain injury in New South Wales: a multicentre study. Med J Aust. 2012;196:40–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Ventura T, Harrison-Felix C, Carlson N, DiGuiseppi C, Gabella B, Brown A, DeVivo M, Whiteneck G. Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study. Arch Phys Med Rehabil. 2010;91:20–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Tate RL, Broe GA, Cameron ID, Hodgkinson AE, Soo CA. Pre-injury, injury and early post-injury predictors of long-term functional and psychosocial recovery after severe traumatic brain injury. Brain Impair. 2005;6(2):75–89.CrossRefGoogle Scholar
  17. 17.
    Langlois J, Rutland-Brown W, Thomas K. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2004.Google Scholar
  18. 18.
    Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2(7873):81–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Tate RL. A compendium of tests, scales and questionnaires: the practitioner’s guide to measuring outcomes after acquired brain impairment. Hove: Psychology Press; 2010.Google Scholar
  20. 20.
    Jennett B, Teasdale G. Management of head injuries. Philadelphia: F. A. Davis Company; 1981.Google Scholar
  21. 21.
    Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on mild traumatic brain injury. J Rehabil Med. 2004;43 (Suppl):113–25.CrossRefGoogle Scholar
  22. 22.
    Dikmen SS, Ross BL, Machamer JE, Temkin NR. One year psychosocial outcome in head injury. J Int Neuropsychol Soc. 1995;1:67–77.PubMedCrossRefGoogle Scholar
  23. 23.
    Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet. 1975;305(7905):480–4.CrossRefGoogle Scholar
  24. 24.
    Whyte J, Hart T, Laborde A, Rosenthal M. Rehabilitation issues in traumatic brain injury. In: DeLisa JA, Gans MB, Walsh NE, et al., editors. Physical medicine and rehabilitation: principles and practice, vol. 2. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 1677–713.Google Scholar
  25. 25.
    Lammi MH, Smith VH, Tate RL, Taylor CM. The minimally conscious state and recovery potential: a follow-up study 2–5 years after traumatic brain injury. Arch Phys Med Rehabil. 2005;86:746–54.PubMedCrossRefGoogle Scholar
  26. 26.
    Stuss DT, Buckle L. Traumatic brain injury: neuropsychological deficits and evaluation at different stages of recovery and in different pathologic subtypes. J Head Trauma Rehabil. 1992;7(2):40–9.CrossRefGoogle Scholar
  27. 27.
    Carroll LJ, Cassidy JD, Peloso PM, Borg J, von Holst H, Holm L, Paniak C, Pépin M. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on mild traumatic brain injury. J Rehabil Med. 2004;43 (Suppl):84–105.CrossRefGoogle Scholar
  28. 28.
    Tate RL, Harris RD, Cameron ID, Myles BM, Winstanley JB, Hodgkinson AE, Baguley IJ, Harradine PG, On behalf of the Brain Injury Outcomes Study (BIOS) Group. Recovery of impairments after severe traumatic brain injury: findings from a prospective, multicentre study. Brain Impair. 2006;7(1):1–15.CrossRefGoogle Scholar
  29. 29.
    Laxe S, Zasler N, Selb M, Tate R, Tormos JM, Bernabeu M. Development of the International Classification of Functioning, Disability and Health core sets for traumatic brain injury: an international consensus process. Brain Inj. 2013;27(4):379–87.PubMedCrossRefGoogle Scholar
  30. 30.
    Escorpizo R, Ekholm J, Gmünder H-P, Cieza A, Kostanjsek N, Stucki G. Developing a core set to describe functioning in vocational rehabilitation using the International Classification of Functioning, Disability, and Health (ICF). J Occup Rehabil. 2010;20:502–11.PubMedCrossRefGoogle Scholar
  31. 31.
    Finger ME, Escorpizo R, Glässel A, Gmünder HP, Lückenkemper M, Chan C, Fritz J, Studer U, Ekholm J, Kostanjsek N, Stucki G, Cieza A. ICF Core Set for vocational rehabilitation: results of an international consensus conference. Disabil Rehabil. 2012;34(5):429–38.PubMedCrossRefGoogle Scholar
  32. 32.
    Koskinen S, Hokkinen E-M, Sarajuuri J, Alaranta H. Applicability of the ICF checklist to traumatically brain-injured patients in post-acute rehabilitation settings. J Rehabil Med. 2007;39:467–72.PubMedCrossRefGoogle Scholar
  33. 33.
    Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological assessment. 5th ed. New York: Oxford University Press; 2012.Google Scholar
  34. 34.
    Tate RL, Godbee K, Sigmundsdottir L. A systematic review of assessment tools for adults used in traumatic brain injury research. NeuroRehabilitation. 2013;32:729–50.PubMedGoogle Scholar
  35. 35.
    Baddeley AD, Kopelman MD, Wilson BA, editors. Handbook of memory disorders. 2nd ed. Hoboken: Wiley; 2002.Google Scholar
  36. 36.
    Agency for Clinical Innovation. Investigation of vocational programs and outcomes for people with traumatic brain injury in New South Wales. Sydney: Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation; 2013.Google Scholar
  37. 37.
    Powell TJ, Collin C, Sutton K. A follow-up study of patients hospitalized after minor head injury. Disabil Rehabil. 1996;18(5):231–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Johnstone B, Vessell R, Bounds T, Hoskins S, Sherman A. Predictors of success for state vocational rehabilitation clients with traumatic brain injury. Arch Phys Med Rehabil. 2003;84(2):161–7.PubMedCrossRefGoogle Scholar
  39. 39.
    van der Naalt J, van Zomeren A, Sluiter W, Minderhoud J. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry. 1999;66(2):207–13.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Harradine PG, Winstanley JB, Tate R, Cameron ID, Baguley IJ, Harris RD. Severe traumatic brain injury in New South Wales: comparable outcomes for rural and urban residents. Med J Aust. 2004;181(3):130–4.PubMedGoogle Scholar
  41. 41.
    Lippert-Grüner M, Lefering R, Svestkova O. Functional outcome at 1 vs. 2 years after severe traumatic brain injury. Brain Inj. 2007;21(10):1001–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Sander AM, Kreutzer JS, Rosenthal M, Delmonico R, Young ME. A multicenter longitudinal investigation of return to work and community integration following traumatic brain injury. J Head Trauma Rehabil. 1996;11(5):70–84.CrossRefGoogle Scholar
  43. 43.
    Graumeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers M. A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury. Arch Phys Med Rehabil. 2012;93:993–9.CrossRefGoogle Scholar
  44. 44.
    Olver JH, Ponsford JL, Curran CA. Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury. Brain Inj. 1996;10(11):841–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Anderson V, Brown S, Newitt H, Hoile H. Long-term outcome from childhood traumatic brain injury: intellectual ability, personality, and quality of life. Neuropsychology. 2011;25(2):176–84.PubMedCrossRefGoogle Scholar
  46. 46.
    Nybo T, Sianio M, Müller K. Stability of vocational outcome in adulthood after moderate to severe preschool brain injury. J Int Neuropsychol Soc. 2004;10:719–23.PubMedGoogle Scholar
  47. 47.
    Anderson V, Brown S, Newitt H, Hoile H. Educational, vocational, psychosocial, and quality of life outcomes for adult survivors of childhood traumatic brain injury. J Head Trauma Rehabil. 2009;24(5):303–12.PubMedCrossRefGoogle Scholar
  48. 48.
    Nightingale EJ, Soo CA, Tate RL. A systematic review of early prognostic factors for return to work after traumatic brain injury. Brain Impair. 2007;8(2):101–42.CrossRefGoogle Scholar
  49. 49.
    Temkin NR, Holubkov R, Machamer JE, Winn HR, Dikmen SS. Classification and regression trees (CART) for prediction of function at 1 year following head trauma. J Neurosurg. 1995;82:764–71.PubMedCrossRefGoogle Scholar
  50. 50.
    van Velzen JM, van Bennekom CAM, Edelaar MJA, Sluiter JK, Frings-Dresen MHW. Prognostic factors of return to work after acquired brain injury: a systematic review. Brain Inj. 2009;23:385–95.PubMedCrossRefGoogle Scholar
  51. 51.
    Fourtassi M, Hajjioui A, El Ouahabi A, Benmassaoud H, Hajjaj-Hassouni N, El Khamlichi A. Long term outcome following mild traumatic brain injury in Moroccan patients. Clin Neurol Neurosurg. 2011;113:716–20.PubMedCrossRefGoogle Scholar
  52. 52.
    Friedland JF, Dawson DR. Function after motor vehicle accidents: a prospective study of mild head injury and posttraumatic stress. J Nerv Ment Dis. 2001;189:426–34.PubMedCrossRefGoogle Scholar
  53. 53.
    Stulemeijer M, van der Werf S, Borm GF, Vos PE. Early prediction of favourable recovery 6 months after mild traumatic brain injury. J Neurol Neurosurg Psychiatry. 2008;79:936–42.PubMedCrossRefGoogle Scholar
  54. 54.
    Tyerman A. Vocational rehabilitation after traumatic brain injury: models and services. NeuroRehabilitation. 2012;31(1):51–62.PubMedGoogle Scholar
  55. 55.
    Kendall E, Muenchberger H, Gee T. Vocational rehabilitation following traumatic brain injury: a quantitative synthesis of outcome studies. J Vocat Rehabil. 2006;25:149–60.Google Scholar
  56. 56.
    Fadyl JK, McPherson KM. Approaches to vocational rehabilitation after traumatic brain injury: a review of the evidence. J Head Trauma Rehabil. 2009;24(3):195–212.PubMedCrossRefGoogle Scholar
  57. 57.
    Klonoff PS, Lamb DG, Henderson SW. Milieu-based neurorehabilitation in patients with traumatic brain injury: outcome at up to 11 years postdischarge. Arch Phys Med Rehabil. 2001;81(11):1535–7.CrossRefGoogle Scholar
  58. 58.
    Ownsworth T. A metacognitive contextual approach for facilitating return to work following acquired brain injury: three descriptive case studies. Work. 2010;36(4):381–8.PubMedGoogle Scholar
  59. 59.
    Buffington AL, Malec JF. The vocational rehabilitation continuum: maximizing outcomes through bridging the gap from hospital to community-based services. J Head Trauma Rehabil. 1997;12(5):1–13.CrossRefGoogle Scholar
  60. 60.
    Malec JF, Moessner AM. Replicated positive results for the VCC model of vocational intervention after ABI within the social model of disability. Brain Inj. 2006;20(3):227–36.PubMedCrossRefGoogle Scholar
  61. 61.
    Gamble D, Moore CL. Supported employment: disparities in vocational rehabilitation outcomes, expenditures and service time for persons with traumatic brain injury. J Vocat Rehabil. 2003;19(1):47–57.Google Scholar
  62. 62.
    Wehman P, Kregel J, Keyser-Marcus L, Sherron-Targett P, Campbell L, West M, Cifu DX. Supported employment for persons with traumatic brain injury: a preliminary investigation of long-term follow-up costs and program efficiency. Arch Phys Med Rehabil. 2003;84(2):192–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Babineau JL. The value of early placement in a supported employment program for individuals with traumatic brain injury. Work. 1998;10(2):137–46.PubMedCrossRefGoogle Scholar
  64. 64.
    Chestnut RM, Carney N, Maynard H, Patterson P, Mann NC, Helfand M. Rehabilitation for traumatic brain injury (Report No. 99-E006). Rockville: Agency for Health Care Policy and Research; 1999.Google Scholar
  65. 65.
    Wehman PH, West MD, Kregel J, Sherron P, Kreutzer JS. Return to work for persons with severe traumatic brain injury: a data-based approach to program development. J Head Trauma Rehabil. 1995;10(1):27–39.CrossRefGoogle Scholar
  66. 66.
    Murphy L, Chamberlain E, Weir J, Berry A, Nathaniel-James D, Agnew R. Effectiveness of vocational rehabilitation following acquired brain injury: preliminary evaluation of a UK specialist rehabilitation programme. Brain Inj. 2006;20(11):1119–29.PubMedCrossRefGoogle Scholar
  67. 67.
    Tyerman A, Young K. Vocational rehabilitation after severe traumatic brain injury: II-specialist interventions and outcomes. J Occup Psychol Employ Disabil. 2000;2(2):13–20.Google Scholar
  68. 68.
    Stergiou-Kita M, Dawson D, Rappolt S. An integrated review of the processes and factors relevant to vocational evaluation following traumatic brain injury. J Occup Rehabil. 2011;21(3):374–94.PubMedCrossRefGoogle Scholar
  69. 69.
    Sandqvist JL, Tornquist KB, Henriksson CM. Assessment of Work Performance (AWP) – development of an instrument. Work. 2006;26:379–87.PubMedGoogle Scholar
  70. 70.
    Bootes K, Chapparo CJ. Cognitive and behavioural assessment of people with traumatic brain injury in the workplace: occupational therapists’ perceptions. Work. 2002;19:255–68.PubMedGoogle Scholar
  71. 71.
    Fisher AG. Assessment of motor and process skills. 3rd ed. Fort Collins: Three Star Press; 1997.Google Scholar
  72. 72.
    Donovan NJ, Heaton SC, Kimberg CI, Wen P, Waid-Ebbs JK, Coster W, Singletary F, Velozo CA. Conceptualizing functional cognition in traumatic brain injury rehabilitation. Brain Inj. 2011;25(4):348–64.PubMedCrossRefGoogle Scholar
  73. 73.
    Johansson CB. Career Assessment Inventory: the advanced version. San Antonio: Pearson; 2003.Google Scholar
  74. 74.
    Pryer R. Occupational Search Inventory manual (Form 3). Sydney: Congruence; 2006.Google Scholar
  75. 75.
    Wilkinson GS. Wide range achievement test 3 manual. Wilmington: Psychological Assessment Resources; 1993.Google Scholar
  76. 76.
    Occupational Health, Safety and Workers’ Compensation. Job demands analysis procedure manual: behavioural/cognitive job demands analysis. Toronto: City of Toronto; 2003.Google Scholar
  77. 77.
    Kowalske K, Plenger PM, Lusby B, Hayden ME. Vocational re-entry following TBI: an enablement model. J Head Trauma Rehabil. 2000;15(4):989–99.PubMedCrossRefGoogle Scholar
  78. 78.
    O’Brien L. Achieving a successful and sustainable return to the workforce after ABI: a client-centred approach. Brain Inj. 2007;21(5):465–78.PubMedCrossRefGoogle Scholar
  79. 79.
    Yasuda S, Wehman P, Targett P, Cifu D, West M. Return to work for persons with traumatic brain injury. Am J Phys Med Rehabil. 2001;80(11):852–64.PubMedCrossRefGoogle Scholar
  80. 80.
    Wehman PH, Kreutzer JS, West MD, Sherron PD, Zasler ND, Groah CH, Stonnington HH, Burns CT, Sale PR. Return to work for persons with traumatic brain injury: a supported employment approach. Arch Phys Med Rehabil. 1990;71(13):1047–52.PubMedGoogle Scholar
  81. 81.
    Holzberg E. The best practice for gaining and maintaining employment for individuals with TBI. Work. 2001;16:245–58.PubMedGoogle Scholar
  82. 82.
    Macaden AS, Chandler BJ, Chandler C, Berry A. Sustaining employment after vocational rehabilitation in acquired brain injury. Disabil Rehabil. 2010;32(14):1140–7.PubMedCrossRefGoogle Scholar
  83. 83.
    Sale P, West M, Sherron P, Wehman PH. Exploratory analysis of job separations from supported employment for persons with traumatic brain injury. J Head Trauma Rehabil. 1991;6:1–11.CrossRefGoogle Scholar
  84. 84.
    Catalano D, Pereira AP, Wu M, Ho H, Chan F. Service patterns related to successful employment outcomes of persons with traumatic brain injury in vocational rehabilitation. NeuroRehabilitation. 2006;21(4):279–93.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Robyn L. Tate
    • 1
    Email author
  • Grahame K. Simpson
    • 1
    • 2
    • 3
  • Philippa McRae
    • 2
    • 3
  1. 1.John Walsh Centre for Rehabilitation ResearchSydney Medical School – Northern, Level 9, Kolling Institute of Medical Research, University of Sydney, Royal North Shore HospitalSt. LeonardsAustralia
  2. 2.Liverpool Brain Injury Rehabilitation UnitLiverpool HospitalSydneyAustralia
  3. 3.Brain Injury Rehabilitation Research GroupIngham Institute of Applied Medical ResearchSydneyAustralia

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