Carolyn W. Graham

Hyperbaric oxygen for blast‐related postconcussion syndrome: Three‐month outcomes

Mild traumatic brain injury (mTBI) and postconcussion syndrome (PCS) are common among military combatants. Hyperbaric oxygen (HBO2) is a proposed treatment for these conditions, but it has not been rigorously studied. The objective of this study was to determine the effects of HBO2 by 3 months post compression at 2 commonly employed dosing levels to treat PCS; whether specific subgroups may have benefited; and if no overall effect was found, whether benefit is masked by other conditions.

Employment Interventions for Individuals with ASD: The Relative Efficacy of Supported Employment With or Without Prior Project SEARCH Training.

This paper presents findings from a retrospective observational records review study that compares the outcomes associated with implementation of supported employment (SE) with and without prior Project SEARCH with ASD Supports (PS-ASD) on wages earned, time spent in intervention, and job retention. Results suggest that SE resulted in competitive employment for 45 adults with ASD. Twenty-five individuals received prior intervention through PS-ASD while the other 20 individuals received SE only. Individuals in this sample who received PS-ASD required fewer hours of intervention. Additionally, individuals in the PS-ASD group achieved a mean higher wage and had higher retention rates than their peers who received SE only. Further research with a larger sample is needed to confirm these findings.

Subjective Sleep Disturbance in Veterans Receiving Care in the Veterans Affairs Polytrauma System Following Blast-Related Mild Traumatic Brain Injury

OBJECTIVES This investigation sought to characterize prevalence and factors associated with subjective sleep disturbance (SSD) in a clinical sample of veterans with blast-related mild traumatic brain injury (mTBI). METHODS Adult veterans with history of blast-related mTBI were enrolled in a cross-sectional study. Data on demographics, injury, and current symptoms, including SSD, were obtained. Descriptive and univariate analyses investigated prevalence of SSD and associated factors. RESULTS Participants were 114 veterans with blast-related mTBI (96% male; mean age = 31 years, SD = 8; mean number of days since injury =1,044, SD = 538). 78% screened positive for post-traumatic stress disorder and 77% reported SSD. Loss of consciousness at time of injury, current nightmares, depression, headache, fatigue, and positive screen for post-traumatic stress disorder were significantly associated with SSD (p < 0.05). CONCLUSIONS SSD was pervasive in this clinical sample and was significantly associated with multiple modifiable emotional symptoms as well as headache and fatigue; this is consistent with previous literature including samples with history of nonblast-related mTBI. Future research incorporating objective measurement of SSD and associated symptoms is needed to inform evidence-based screening, assessment, and treatment efforts for veterans with history of mTBI.

Moving employment research into practice: Knowledge and application of evidence-based practices by state vocational rehabilitation agency staff

The objective of this study was to identify barriers and facilitators to the use of evidence by professional staff of state Vocational Rehabilitation (VR) agencies. Data were collected via an online survey administered to 355 staff at three state VR departments. Over half of respondents could locate and comprehend research findings. Evidence-based practice (EBP) was not widely encouraged, but there was a positive relationship between the agency having sufficient funds and its support for EBP (r = 0.27, p = 0.001). The top two sources of information respondents used on the job were professional collaboration and the Internet, but not social media. State VR agencies tend not to expect that counselors will use EBP and provide limited incentives for them to do so. While VR staff value research and are open to trying new strategies based on research, translating evidence into usable and accessible products and developing efficient delivery strategies present challenges that the authors intend to investigate further in upcoming research. Knowledge translation strategies need to be developed for this audience.

Effects of an employer-based intervention on employment outcomes for youth with significant support needs due to autism

The purpose of this study was to develop and investigate an employer-based 9-month intervention for high school youth with autism spectrum disorder to learn job skills and acquire employment. The intervention modified a program titled Project SEARCH and incorporated the use of applied behavior analysis to develop Project SEARCH plus Autism Spectrum Disorder Supports. A randomized clinical trial compared the implementation of Project SEARCH plus Autism Spectrum Disorder Supports with high school special education services as usual. Participants were 49 high-school-aged individuals between the ages of 18 and 21 years diagnosed with an autism spectrum disorder and eligible for supported employment. Students also had to demonstrate independent self-care. At 3 months post-graduation, 90% of the treatment group acquired competitive, part-time employment earning US

Improving the employment outcomes of individuals with traumatic brain injury: The effectiveness of knowledge translation strategies to impact the use of evidence-based practices by vocational rehabilitation counselors

9.53–US

Barriers and facilitators to employment as reported by people with physical disabilities: An across disability type analysis

10.66 per hour. Furthermore, 87% of those individuals maintained employment at 12 months post-graduation. The control group’s employment outcomes were 6% acquiring employment by 3 months post-graduation and 12% acquiring employment by 12 months post-graduation. The positive employment outcomes generated by the treatment group provide evidence that youth with autism spectrum disorder can gain and maintain competitive employment. Additionally, there is evidence that they are able to advance within that time toward more weekly hours worked, while they also displayed increasing independence in the work setting.

Competitive Employment for Youth with Autism Spectrum Disorders: Early Results from a Randomized Clinical Trial

OBJECTIVE: The objective of this study was to compare the effects of two knowledge translation (KT) strategies on the knowledge and future actions of vocational rehabilitation (VR) counselors when supporting individuals with traumatic brain injury (TBI). DESIGN: The study used a randomized pretest-posttest control group design. PARTICIPANTS: Participants were professional staff recruited from a single state VR agency who volunteered to participate in the study. The majority were female counselors with Master’s degrees. PROCEDURE: Participants were randomly assigned to one of two groups. Both groups received the same information on supported employment for individuals with traumatic brain injury (TBI) over a three month period. One group received the information via pre-recorded video presentations that were posted on an unlisted YouTube channel. The second group received the identical information via three briefs. At the beginning of each of the three months, each participant received either an email with the link to a pre-recorded presentation on YouTube or an email with the brief attached depending on the group assignment. The information could be accessed at their convenience across the one month period. Participants were assessed pre- and post-intervention with a Likert-scale instrument designed to measure knowledge of TBI, the effects of TBI on employment, and the efficacy of the supported employment approach for this group. In addition, participants were asked pre- and posttest how likely they were to fund services related to supported employment for individuals with TBI.

Defining customized employment as an evidence-based practice: The results of a focus group study

BACKGROUND: Extant research has reported on the factors associated with seeking and maintaining employment for individuals with different types of physical disabilities, such as cerebral palsy (CP), multiple sclerosis (MS), and spinal cord injuries (SCI). Some of these factors are barriers and others are facilitators. However, research has not determined whether the inhibiting and facilitating employment experiences of people with physical disabilities are similar across type of physical disability. OBJECTIVE: The goal of this study was to compare the employment experiences of people with physical disabilities with three different disabilities including CP, MS, and SCI to determine whether these employment experiences are similar. METHODS: Homogenous focus groups were conducted with individuals with CP, MS, and SCI concerning their employment experiences. These 18 focus groups were conducted telephonically, audio recorded, and lasted approximately 60 minutes each. Data from each disability type was analyzed separately and across disability type. RESULTS: Two themes were common among participants in the three disability types: 1) Health and 2) Barriers to Overcome. However, there were differences among the disability types within these themes. Some of these differences were unique to MS. CONCLUSIONS: This study provides a perspective on working with CP, MS, or SCI informed directly by individuals living with these disabilities, whether they were employed or unemployed, and gives a voice to the employment experiences of the individuals. The findings present information on the similarities and differences that individuals with various physical disabilities face when working.