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Biomedical subjects

R T Fraser

Publications and source records attributed to R T Fraser.

10 recordsLinked to original sources

Improving functional rehabilitation outcome following epilepsy surgery.

This article reviews the literature on rehabilitation outcome following epilepsy surgery to provide perspective on the research issues in examining vocational and independent living outcome. The existing literature does not suggest dramatic independent living or employment gains as a result of this surgery. Those most likely to profit in these areas are adult seizure patients with excellent surgical outcome, freedom from pre-existing impairments (psychiatric, neuropsychological, or financial dependence on subsidy), and recent presurgical vocational activity. Recommendations are offered toward improving this outcome.

Activities of Daily Living

Epilepsy rehabilitation: evaluating specialized versus general agency outcome.

This 1982 study was a retrospective comparison of vocational outcome between eight state rehabilitation agencies and the University of Washington Epilepsy Center's Vocational Unit for the years 1977-1978. Hypotheses included: (a) A significantly higher portion of those with epilepsy will find employment through a specialized (i.e., Epilepsy Center) versus a general rehabilitation program. (b) A specialized program will have a significantly lower proportion of program dropouts. (c) Those finding jobs through a specialized program will earn higher salaries and have better job retention than those employing a general agency program. On several comparisons the specialized program outperformed the general agencies--higher proportion of successful job placements and lower proportions of dropouts and those remaining in process (all chi2 tests significant at the p less than 0.001 level). Placement rates for specialized programs have traditionally approximated 50%, whereas these state agencies placed from 9 to 21%. Salary level and job retention differences were inconclusive. Data implications are discussed.

Employment

Program evaluation in epilepsy rehabilitation.

The Vocational Services Program of the University of Washington Regional Epilepsy Center is described, and data relating to the first 106 clients who entered the program are examined. A major emphasis of the study was characteristic differences between those clients later competitively employed and program dropouts. Other study purposes related to examining client satisfaction ratings of different aspects of services and establishing whether a relationship existed between seizure occurrences and job loss. Stepwise discriminant function analysis indicated that "months employed in the last 24" appeared to be the stable discriminator between the employed and dropout groups. The group later employed averaged 12 of the prior 24 months in employment, whereas dropouts approximated 7. Associated psychiatric/addictions treatment was initially a key outcome discriminator, but it did not hold up on cross-validation. Subjects were more satisfied with individualized client services (e.g., counseling sessions) than with group activities (e.g., Job Club). As opposed to seizures, emotional/attitudinal difficulties with this rehabilitation population appeared to be the primary reason for job loss. A work adjustment or job station program can be critical for these individuals and others with neurological impairments. The importance of counselor follow-up after the initial job placement is also underscored. This program, with about half of its clients entering unsubsidized jobs, basically replicated the results of other community-oriented epilepsy rehabilitation programs.

Academic Medical Centers

Epilepsy.

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Activities of Daily Living

Futher validation of the WPSI vocational scale: comparisons with other correlates of employment in epilepsy.

The present study evaluates the relationships between employment status and five types of variables: years of education, intelligence, emotional adjustment, neuropsychological impairment, and psychosocial adjustment. The latter two areas were evaluated by procedures specifically developed for work with seizure patients and include use of the Neuropsychological Battery for Epilepsy and the Washington Psychosocial Seizure Inventory. Fifty-eight patients were divided into groups based on their employment histories and classified as unemployed, underemployed, and employed. Results indicated that the two types of procedures developed specifically for work with clients having seizures demonstrated the most potent and consistent relationships with employment status. The study suggests that the use of these procedures in the evaluation of employability may be more effective than using only those variables which traditionally have been applied.

Adolescent

The difficult-to-employ in epilepsy rehabilitation: predictions of response to an intensive intervention.

In this prospective study, 46 adult seizure outpatients with suspected brain impairment were referred for vocational services at the University of Washington Regional Epilepsy Center and counseled for job placement. Among the demographic, intellectual, neuropsychological, and psychosocial variables considered, the Wechsler Adult Intelligence Scale (WAIS) Digit Symbol subtest and the name-writing procedure from the neuropsychological battery by Dodrill (1978) were the best discriminators of later employability. Using discriminant function analysis, these two tests correctly classified 75.0% of the group which ultimately became employed (n = 22) and 73.9% of the group which did not attain employment (n = 26). Implications of these findings are discussed in relation to rehabilitation planning.

Adolescent