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Biomedical subjects

P Wehman

Publications and source records attributed to P Wehman.

At least 19 recordsLinked to original sources
PubMed2001

Return to work for persons with traumatic brain injury.

Individuals with traumatic brain injuries experience an array of physical, cognitive, and emotional changes that often make return to preinjury employment unlikely and locating new employment difficult. The authors review the literature related to the return to work for persons with traumatic brain injuries. This includes return to work outcomes, factors influencing return to work, and vocational programs that enhance employment, including a supported employment approach. Guidelines for professionals engaged in supported employment practices are also provided.

Brain Injuries↗
PubMed2001

Determining impairment following spinal cord injury.

Determining the level of impairment and disability of an individual with SCI is reasonably straightforward. An impairment rating may be determined by either analyzing the impact of the SCI on various bodily systems or by considering the injury as a more global diagnostic category. Functional abilities based on level of neurologic preservation are well recognized. Although secondary medical complications, which may affect both impairment and disability, can arise at any time after SCI, neurologic and functional abilities are overwhelmingly stabilized by 12 months postinjury. A comprehensive history and physical examination should allow even the inexperienced examiner to obtain a valid determination of impairment after SCI. Although a more functionally oriented and perhaps interdisciplinary evaluation is needed to assess disability, it is also fairly straightforward. On the other hand, an evaluation of handicap is a more challenging undertaking, requiring a more detailed knowledge of the field of vocational rehabilitation.

Adult↗
PubMed1999

An evaluation of affected-sib-pair methods and transmission/disequilibrium tests for detecting genes underlying a complex trait.

For the analysis of complex traits, it is of interest to compare a few nonparametric methods such as affected-sib-pair (ASP) analyses and transmission/disequilibrium tests (TDT). The affected-sib-pair approaches we have examined here are ASP and ALL-SP which are implemented in SIBPAIR program. We also applied the BETA program which has not so far been extensively compared with other methods. The study indicates that the ASP program and the BETA program give concordant results although BETA tends to give higher lod scores. However, when all sibs were included in the analysis (ALL-SP), linkage signals became weaker, compared with ASP and BETA. The TDT detected 66 positive signals at a significance level of 0.05 and identified a true locus. Overall, our results suggest that affected-sib-pair analysis has reasonable power (p < 0.0001) to detect linkage given the disease model and the family structure specified in the GAW11 Problem 2 data set.

Genetic Testing↗
PubMed1998

Enhancing work outcome for three persons with traumatic brain injury.

A case study approach is used to illustrate how three survivors of severe traumatic brain injury were able to gain and maintain employment with the assistance of a supported employment programme. Emphasis on the different types of accommodations, including the design and implementation of compensatory strategies, is provided for each case. Finally, on overview of steps that can be taken to enhance the use of such strategies on the job is presented.

Adult↗
PubMed1997

Acute predictors of successful return to work 1 year after traumatic brain injury: a multicenter analysis.

OBJECTIVE: To investigate the influence of acute injury characteristics on subsequent return to work in traumatic brain injury (TBI) patients. DESIGN: Descriptive statistics were performed in a comparative study of 49 TBI patients who were competitively employed at 1-year follow-up and 83 unemployed patients. Independent t tests were then performed to examine the differences between the two groups on specific measures including the Disability Rating Scale (DRS), Functional Assessment Measure (FIM), Rancho Los Amigos Scale (RLAS), Glasgow Coma Scale (GCS), Neurobehavioral Rating Scale (NRS), and neuropsychological test results. SETTING: Four medical centers in the federally sponsored Traumatic Brain Injury Model Systems Project that provide emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. PARTICIPANTS: Patients were selected from a national database of 245 rehabilitation inpatients admitted to acute care within 8 hours of TBI and seen at 1-year follow-up. MAIN OUTCOME MEASURE: Return to work at 1-year follow-up. RESULTS: Persons employed at 1-year follow-up obtained significantly better scores on specific acute measures of physical functioning (Admission FIM, Admission DRS, Discharge DRS), cognitive functioning (Logical Memory Delay), behavioral functioning (Admission RLAS, Discharge RLAS, NRS Excitement factor), and injury severity (Admission GCS, Highest GCS, Length of Coma, Length of PTA) than their unemployed counterparts. CONCLUSIONS: Persons obtaining better scores on certain acute measures (e.g., Admission GCS) are more likely to return to the workforce. Future research should focus on developing a standardized tool to assess a patient's ability to return to work, as well as an operational definition for successful employment.

Adult↗
PubMed1995

Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations.

The psychosocial problems of decreased social contact, depression, and loneliness that occur for many with traumatic brain injury (TBI) create a major challenge for enhancing efforts at community re-entry. Despite dramatic physical progress within the first six months after injury, these psychosocial problems remain a persistent long-term problem for the majority of individuals with severe TBI. Researchers have consistently suggested that the psychosocial problems associated with TBI may actually be the major challenge facing rehabilitation. The majority of individuals who sustain TBI are young males between the ages of 19 and 25, who are in the early stages of establishing their independence in areas including friendships, leisure activities, intimate relationships, residence, and employment. The problem of social isolation and decreased leisure activities create a renewed dependence of the survivor on his/her family to meet these needs. In this article we review a large number of papers which examine the psychosocial and emotional sequelae for TBI patients. The results of those studies demonstrate four primary themes. The first theme depicts that individuals who experience severe TBI are at high risk for a significant decrease in their friendships and social support. The second theme relates to the lack of opportunity for establishing new social contacts and friends. The third theme relates to the decrease in leisure activities for individuals with severe TBI. Finally, anxiety and depression are found at high levels for prolonged periods of time following severe TBI. Several clinical recommendations are drawn from this literature review. They are: (1) Clinicians such as psychiatric social workers, psychologists, or psychiatrists may need to be called upon more quickly for intervention. The treating physiatrist cannot be expected to provide the insight and frequency of psychological services that may be necessary for many of these patients. (2) Since the literature seems to suggest that the presence of one psychosocial deficit, e.g., anxiety, will often be followed by other similar types of problems, e.g. depression, the treatment team needs to be sensitive to how rapidly these problems can cascade into a very dangerous situation. (3) Perhaps the most compelling recommendation we can make is for community rehabilitation specialists to focus significantly more energies and resources upon the psychological health of clients with TBI. Staff need to be trained to detect these signals that clients with TBI are often sending. It is apparent that psychosocial factors contribute to a rising obstacle level to community adjustment.

Activities of Daily Living↗
PubMed1993

Changes in HIV rates and sexual behavior among homosexual men, 1984 to 1988/92.

Data were collected from 1614 homosexual and bisexual men in 1984 through 1985 and from 1988 to 1992 in Pittsburgh. Of the men entering the study since 1988, 16% reported engaging in unprotected anal receptive intercourse with more than one partner during the 6 months before their visit. Approximately 7% of the younger men and 18% of the men over 22 years of age in the recent cohort were already infected with the human immunodeficiency virus, the same rates as those described 8 years ago. Aggressive risk-reduction programs are needed in high schools and existing networks in the gay community.

Adolescent↗
PubMed1993

Return to work for persons following severe traumatic brain injury. Supported employment outcomes after five years.

Supported employment is a recently developed rehabilitation alternative that is being used to assist individuals with traumatic brain injury to return to work. The present study reports the results of a supported employment program that has placed 80 individuals into competitive employment during a 5-year time period. All individuals had sustained a severe traumatic brain injury; 72% of the injuries involved a motor vehicle. A mean of 6.1 years had passed since injury for all participants, who had been unconscious an average of 48 days. Neuropsychologic evaluation revealed defective cognitive functioning, which contributed to diminished employment potential. A key outcome indicator used to assess return to work capacity is the monthly employment ratio, which is computed by dividing the number of months employed during an employment phase (i.e., pre/post injury) by the total possible months an individual would have the opportunity to be employed. The monthly employment ratio increased from 13% after injury with no supported employment to 67% with supported employment services. The majority of individuals were employed in warehouse, clerical and service-related occupations. A mean of 250 staff intervention hours were required to train and provide follow-up services to program participants.

Adolescent↗
PubMed1991

Costs of operating a supported work program for traumatically brain-injured individuals.

This paper presents a preliminary analysis of costs associated with a return-to-work program emphasizing a supported employment approach for persons who had sustained severe traumatic brain injuries. This analysis spans almost three years. Results indicated that a mean of 237.8 hours of staff intervention time was required to achieve job stabilization, at a cost of +6896. Ongoing follow-along and support services averaged 1.64 hours per week at a cost of +47.56. Over 68% of total staff time and costs were expended in job-site training and advocacy efforts. Application of these findings to state-level and agency-level policies should be weighed against individual characteristics and needs of clients, program design, and outcomes which clients achieve as a result of services.

Adolescent↗
PubMed1990

Supported employment for persons with severe and profound mental retardation: a critical analysis.

An analysis of the employment outcomes of 109 persons with severe profound mental retardation was undertaken. The mean age of the group was 28 years and mean intelligence quotient (Stanford-Binet) was 30. The data were drawn from over 90 local community programmes in the United States. Results indicated that all persons were in supervised residential situations and that 93% of the total were competitively employed with the mean wage being $3.63 per hour. Mean hours of weekly employment were 22 hours. After 12 months of placement, 81.5% of the clients were still employed. Supported employment has provided new work opportunities for a group of people long reviewed as permanently unemployable.

Activities of Daily Living↗
PubMed1990

Helping postacute traumatically brain injured clients return to work: three case studies.

This paper presents three case studies of individuals who had sustained a severe brain injury and who are clients of a return to work programme emphasizing a supported employment approach. The case studies illustrate the types of interventions which are utilized, including job placement; job site and off-site training, advocacy, and compensatory strategies; and ongoing assessment and maintenance of social and productive gains in order to assist with job retention. The results of the case studies may be generalized to the population of brain injury survivors who require intensive and long-term intervention and support in order to return to employment.

Adult↗
PubMed1990

National supported employment initiative: a preliminary analysis.

A survey of 27 states receiving federal supported employment grants was conducted. Results indicated that the number of participating individuals increased 157% during the 3-year study period. Further, over 1,400 programs of supported employment were authorized by state agencies during this time. Individual placement options remained prevalent and employment outcomes associated with this approach appeared to be superior to outcomes associated with other models. Persons with mental retardation were the most frequent participants; individuals experiencing other handicapping conditions or those considered severely handicapped were not well represented. Implications of these results for the continued implementation of this new service alternative were discussed.

Disability Evaluation↗
PubMed1989

Effect of supported employment on the vocational outcomes of persons with traumatic brain injury.

This paper reports the job placement of 5 males with severe traumatic brain injury. An individual placement model of supported employment was used. All individuals were placed in competitive employment and received staggered intervention over time by trained employment specialists. A multiple baseline design across persons was used to evaluate results. All individuals had been unable to work consistently or at all in competitive work environments. The range of wages was $4.25 to $5.00 per hour with an average of 339 hours of employment specialist intervention time required per case. The major problems experienced by employment specialists were insubordinate and disruptive behaviors as well as other inappropriate social behaviors displayed at the job site.

Adult↗
PubMed1989

The effects of consumer characteristics and type of employment model on individual outcomes in supported employment.

Although recent federal legislation has led to a proliferation of supported employment programs throughout the country, little information is available that documents the success of these programs. In the present study, we examined the effect of different consumer characteristics and alternative supported employment service delivery models on key employment outcomes including hourly wage, hours worked per week, increase in earnings after supported employment participation, and level of integration on the job. The employment outcomes of a sample of 1,550 individuals receiving supported employment services through 96 local programs in eight states were analyzed to determine the effects of the key independent variables of primary disability and type of employment model. Results indicate that all groups of individuals, regardless of their primary disability, benefited significantly from supported employment participation. Further, data indicate that the individual placement model generated employment outcomes superior to those resulting from group employment options, particularly work crews. Implications of the results for future program development activities are discussed.

Persons with Disabilities↗
PubMed1989

Helping traumatically brain injured patients return to work with supported employment: three case studies.

Three case studies illustrating the use of supported employment methods to help individuals with severe head injury are presented. Before supported employment intervention, these individuals were unable either to obtain or maintain employment. Neuropsychologic evaluation revealed many intellectual impairments which contributed to diminished employment potential. Through intervention, all three persons were able to obtain and maintain employment. Consecutive number of months employed ranged from 17.5 to 35, and hours worked per week ranged from 30 to 40. Current hourly earnings exceed the minimum wage, ranging from +5.00 to +5.16 per hour. These cases represent a subset within a larger supported employment program, which assists patients with severe traumatic brain injury to reenter the labor force and maintain employment.

Adult↗