Neuropsychological Test Scores Before and After Brain-injury Rehabilitation in Relation to Return to Employment

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Abstract
Neuropsychological tests are widely used not only to assess the degree of dysfunction following a brain injury, but also to assess the effectiveness of rehabilitation procedures in improving cognitive functioning. As yet, however, there is little evidence bearing upon whether any cognitive gains during rehabilitation relate to psychosocial aspects of the patient's subsequent daily life. In the present study 55 non-aphasic brain-injured adult patients were tested, as part of a standard procedure, with a short battery of neuropsychological tests before and after an intensive post-acute rehabilitation programme of about 4–5 months duration. There were significant but small improvements in most test scores after rehabilitation. At a period of between 18 months and 5 years after completion of the programme, a follow-up of the patients was conducted to establish outcomes in terms of whether or not they were actively employed or pursuing an education. This was true in almost 60% of cases. Neuropsychological test scores, in particular before rehabilitation, were generally related to outcome as thus defined, although some of this relationship may have been mediated by age effects. A notable finding was that there was, however, no evidence that improvements in test scores from pre- to post-programme were associated with a positive later outcome. The results suggest that whereas better neuropsychological test results are predictive of a positive outcome, cognitive improvements during rehabilitation as measured by such tests may be only modest and, importantly, they may have little bearing on subsequent return to employment or education. It is suggested that positive outcome in this regard may therefore depend upon other factors.