Date Presented 4/7/2016
In addition to providing education opportunities, social and marital support, and upper-extremity training, this study highlights the occupational therapy intervention targeting specific aspects of executive function for improving work participation in adults with neurological disorders.
Primary Author and Speaker: Alex Wong
Contributing Authors: Carolyn Baum, Cynthia Chen, Alexis Young, Allen Heinemann
PURPOSE: This study was to evaluate selected neurobehavioral functioning as predictors of work participation in community-dwelling adults with neurological conditions.
BACKGROUND: Although employment was recognized as an important part of social participation, identification of key neurobehavioral components of occupational therapy interventions that lead to improve work participation was limited.
DESIGN: Cross-sectional observational study
PARTICIPANTS: The study participants were 534 adults with stroke (n = 193), traumatic brain injury (n = 157), or spinal cord injury (n = 184). They had a median age of 50 yr; 35% were female, and 59% were White.
METHOD: Participants underwent assessment of cognitive, emotional, and motor performance, including the National Institutes of Health Toolbox—Cognitive and Emotional Battery, Executive Function Performance Test, and the Neurology Quality of Life Measurement System. Work participation was measured by self-reported employment status at the time of study. Clinical characteristics were verified from the medical record.
ANALYSIS: The selection of subtests was determined by selecting those that had significant predictive value from each domain. The selected subtests were subjected to a stepwise logistic regression model.
RESULTS: Predictors of work participation included marital status, education, upper-extremity function, and two cognitive domains of executive functioning, sequencing, and inhibitory control. The specific association between depression and work participation was not significant when subtests in other domains were entered into the model.
DISCUSSION: Providing educational opportunities, social–marital support, and upper-extremity–activities of daily living training for neurological populations in occupational therapy interventions are widely acceptable. These data support the critical role of executive function for enhancing work participation after neurological injury. Cognitive remediation and other interventions targeting specific aspects of executive function are of major importance to attempts to improve participation.
IMPACT STATEMENT: Occupational therapists have traditionally recognized that providing education, support, and upper-limb training are associated with the recovery of work functioning. This study highlights efforts to improve specific aspects of executive function that may optimize work participation in stroke, traumatic brain injury, and spinal cord injury.
