Journal of the International Neuropsychological Society

Stability of employment after traumatic brain injury

JOAN  MACHAMER  a1 c1 , NANCY  TEMKIN  a1 a2 a3 , ROBERT  FRASER  a1 a2 a4 , JASON N.  DOCTOR  a1 a5 a6 and SUREYYA  DIKMEN  a1 a2 a7
a1 Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
a2 Department of Neurological Surgery, University of Washington, Seattle, Washington
a3 Department of Biostatistics, University of Washington, Seattle, Washington
a4 Department of Neurology, University of Washington, Seattle, Washington
a5 Department of Medical Education & Biomedical Informatics, University of Washington, Seattle, Washington
a6 Department of Health Services, University of Washington, Seattle, Washington
a7 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

Article author query
machamer j   [PubMed][Google Scholar] 
temkin n   [PubMed][Google Scholar] 
fraser r   [PubMed][Google Scholar] 
doctor jn   [PubMed][Google Scholar] 
dikmen s   [PubMed][Google Scholar] 


Although substantial information exists about factors related to who returns to work and time taken to return to work after traumatic brain injury (TBI), less is known about the stability of the work experience after the injury. One hundred sixty-five workers with complicated mild to severe traumatic brain injury were followed for 3 to 5 years postinjury. Work stability definitions included amount of time worked (amount of time worked divided by time observed postinjury) and maintenance of uninterrupted employment once a person returned to work. Amount of time worked was significantly and systematically related to brain injury severity, neuropsychological functioning at 1-month postinjury, and preinjury characteristics such as prior work stability and earnings. However, once persons returned to work, the ability to maintain uninterrupted employment was largely related to premorbid characteristics such as being older, higher income before the injury, or a preinjury job with benefits. It was also related to higher neuropsychological functioning at 1-month postinjury (reflecting the combined effects of premorbid functioning and traumatic brain injury severity), but not related to neurologic indices of severity. (JINS, 2005, 11, 807–816.)

(Received May 31 2005)
(Revised August 19 2005)
(Accepted August 19 2005)

Key Words: Head injuries; Work; Neuropsychology; Risk factors; Prognosis; Outcome assessment (health care).

c1 Reprint requests to: Joan Machamer, M.A., Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA 98195-6490. E-mail: