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Approaches to Vocational Rehabilitation After Traumatic Brain Injury: A Review of the Evidence

Fadyl, Joanna Kristin BSc; McPherson, Kathryn M. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP

Journal of Head Trauma Rehabilitation: May-June 2009 - Volume 24 - Issue 3 - p 195–212
doi: 10.1097/HTR.0b013e3181a0d458

Background Return to work after traumatic brain injury (TBI) is an important outcome but frequently problematic to achieve. Vocational rehabilitation is commonly recommended as a means of facilitating return to work after TBI. However, there are several different approaches to vocational rehabilitation after TBI and little guidance regarding how to identify the best option for a particular context.

Objectives To (1) identify approaches most commonly underpinning vocational interventions in TBI and (2) evaluate the evidence for effectiveness, strengths and weaknesses, and application of each approach for the TBI population.

Methods Principles of systematic review were used for searching and critiquing articles. Findings are expressed as descriptive synthesis owing to heterogeneity of designs and outcome measures.

Results Three broad categories of vocational rehabilitation for people with TBI were identified on the basis of models that underpin them—program-based vocational rehabilitation, supported employment, and case coordinated. The characteristics, similarities, differences, and applications of each approach are described, as are their strengths and limitations.

Conclusions There is little clear evidence to suggest what should be considered the “best practice” approach to vocational rehabilitation,

School of Rehabilitation and Occupation Studies, AUT University, Auckland, New Zealand.

Corresponding Author: Joanna Kristin Fadyl, BSc, School of Rehabilitation and Occupation Studies, AUT University, Private Bag 92006, Auckland 1142, New Zealand (

© 2009 Lippincott Williams & Wilkins, Inc.