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Neurobehavioral symptoms predictive of employment outcome after traumatic brain injury

Kessler Foundation researchers found a correlation between neurobehavioral symptoms and unemployment among individuals with moderate-to-severe TBI

Kessler Foundation


IMAGE: Dr. Weber, a former Switzer fellow, is a research scientist at Kessler Foundation. view more 

Credit: Kessler Foundation

East Hanover, NJ. September 18, 2018. Kessler Foundation researchers have published their findings linking behavioral symptoms with employment outcomes among adults with moderate to severe traumatic brain injury (TBI). Their findings have implications for strategies aimed at improving employment outcomes in this population. The article, "Impact of frontal neurobehavioral symptoms on employment in individuals with TBI," was epublished ahead of print on July 19 in Rehabilitation Psychology (doi: 10.1037/rep0000208) The authors are Erica Weber, PhD, Angela Spirou, MA, Nancy Chiaravalloti, PhD, and Jeannie Lengenfelder, PhD, of Traumatic Brain Injury Research at Kessler Foundation.

Attaining employment after TBI is challenging. Among those with moderate-to-severe TBI, more than 60% are unemployed. Neural damage to the frontal lobes and white matter tracts often occurs with TBI, resulting in a variety of frontal system neurobehavioral syndromes and an array of overlapping symptoms. Little attention, however, has focused on the influence of these behavioral syndromes on employment.

This study looked at 42 participants (ages 18 to 60) with moderate to severe TBI who were more than one year post injury. Participants were classified as Employed or Unemployed. All underwent neuropsychological evaluation, and were evaluated for depression and fatigue. Information regarding neurobehavioral symptoms (disinhibition, apathy, executive dysfunction), was solicited from the participants using the Frontal Systems Behavior Scale questionnaire; caregivers also provided their assessment of the participants' behaviors pre- and post TBI.

Employed and Unemployed individuals did not differ on tests of neurocognition. There were, however, significant differences between the groups on neurobehavioral tests.

"Our results indicate that frontal neurobehavioral symptoms may be predictive of the ability to achieve and maintain employment after TBI," said Dr. Weber, lead author, and a research scientist at Kessler Foundation. "Developing rehabilitative strategies that address these behaviors could improve employment outcomes," she noted, "and reduce the burden of care on caregivers and society."


This study was supported by the New Jersey Commission on Brain Injury Research (10-3218-BIR-E-0).

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About TBI Research at Kessler Foundation

Nancy Chiaravalloti, PhD, is director of TBI Research and Neuropsychology & Neuroscience Research. Dr. Chiaravalloti is project director of the Northern New Jersey TBI System (NNJTBIS), a collaborative effort of Kessler Foundation, Kessler Institute for Rehabilitation, and local trauma hospitals. John DeLuca, PhD, is co-project director. NNJTBIS is one of 15 federally funded model systems that form a national comprehensive system of care, research, education and dissemination aimed at improving quality of life for people with TBI. NNJTBIS is supported by a grant from the National Institute on Disability & Rehabilitation Research (NIDILRR). In addition to NIDILRR, TBI research is funded by the Department of Defense, New Jersey Commission on Brain Injury Research, the Department of Veterans Affairs, and Children's Specialized Hospital. Kessler researchers and clinicians have faculty appointments in the department of Physical Medicine and Rehabilitation at Rutgers, New Jersey Medical School.

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit Carolann Murphy, PA; 973.324.8382;

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