Employment Interventions for Persons with Mild Cognitive Disorders

Abstract

For purposes of this chapter, we will focus our review on people with mild traumatic brain injury (TBI) and the employment interventions for this population. There are many similarities between mild cognitive impairment (MCI) and mild TBI. MCI has been reported to be between 2.8 and 5.3% of the population (Larrieu et al. 2002) and typically presents as issues with memory, inefficient attention and concentration, and concerns with cognitive fatigue. Londos et al. (2008) indicate that these issues relate more to dementia in the elderly, but in a general cohort, issues such as vascular changes and depression can affect areas of cognitive functioning. Unfortunately, the annual rate of progression to dementia in MCI is in the 12–15% range (Palmer et al. 2003). People with other disabilities such as multiple sclerosis can also have cognitive limitations including fluctuations in memory capacity, word fluency, and speed of information processing (Clemmons et al. 2004). To understand clinical and vocational rehabilitation issues associated with MCI, we will utilize the mild brain injury paradigm because the cognitive issues at 6 months to a year post-injury are relatively stable. With MCI, rehabilitation and job coach personnel are generally dealing with a relatively stable condition rather than progressive cognitive deterioration, which may lead to supported or sheltered employment settings.

The online version of the original chapter can be found at http://dx.doi.org/10.1007/978-1-4419-0428-7_13

An erratum to this chapter can be found at http://dx.doi.org/10.1007/978-1-4419-0428-7_25

Appendix: Disclosure Support Letter

To whom it may concern:

Re: PF

Ms. PF has been a vocational client of the University of Washington’s Neurological Vocational Services for some time. As part of this employment program, we provided a complete vocational assessment and thorough cognitive testing. Ms. PF has excellent abstractive and language skills, in the upper 10% of the population. She has excellent verbal fluency and general fund of information. Her interests tend toward office support activities, and she is particularly project-oriented and well suited to data entry and development projects.

Ms. PF, however, will have some difficulty with multitasking and may require more time to learn a procedure in contrast to the average worker. She simply does an outstanding job if her focus is one project at a time, despite how large the project. Once learned, Ms. PF will perform a job function very well and on a consistent basis. It is hoped that this information is useful to a supervisor, because during initial training the disparity between her learning curve and her actual comprehension abilities may not be well understood. Once learned, she can easily make key decisions. Again, she has strong problem-solving abilities, but can become less efficient if she is spread across multiple duties/projects simultaneously.

Kind regards,

Robert T. Fraser, Ph.D., CRC