[Neuropsychology in occupational rehabilitation: a new field of intervention?]

The main goal of rehabilitation is social and vocational reintegration of handicapped people. Neuropsychological disorders prove to be particularly critical factors in this context. In many cases vocational retraining requiring good cognitive abilities and capacity is essential. Neuropsychological impairments can substantially diminish the chance of successful vocational rehabilitation. To assess the need for neuropsychological intervention within the scope of vocational rehabilitation programmes, 69 persons undergoing rehabilitation in the Berufsförderungswerk Sachsen-Anhalt, a non-profit organization devoted to vocational reintegration, were screened to identify individuals with cognitive deficits. Furthermore a brief multidimensional self-report inventory, the Symptom Checklist-90-R (SCL-90-R) was administered. In addition, the files of all participants were reviewed with regard to mental or neurological disorders. The study revealed cognitive deficits in a quarter to a third of the participants depending on the cognitive domain. Comparison of neuropsychological test performance of trainees with and without established diagnosis of pertinent diseases confirmed cognitive deficits in those with prior diagnosis of neurological disorder, as expected. Only for Divided Attention a significant correlation was found between neuropsychological deficits and psychiatric disorders as documented in the files. However, a considerable number of persons without corresponding medical-psychological pre-diagnosis were found to also perform poorly in particular tests. Furthermore it could be shown that subjectively experienced stress in trainees had a negative impact on reaction times in specific test procedures. These findings strongly suggest a need to supplement vocational rehabilitation by neuropsychological training programmes. When cognitive functional impairments are suspected, specific diagnostic assessments should be administered in order to select and implement appropriate interventions.