Optimizing medical care to facilitate and sustain employment after spinal cord injury

Unemployment among persons with disabilities is a serious and prevalent problem. The Department of Labor's Bureau of Labor Statistics reported that, as of May 2014, the employment rate for people without disabilities was 71.4%, but only 25.3% for persons with any disability, an employment gap of 46.1%. According to a comprehensive review of the literature between 1978 and 2008, the average rate of employment during that period for people with spinal cord injury (SCI) was only 35%. Ways of providing appropriate vocational and medical support for RTW have been developed for both traumatic brain injury (TBI) and serious mental illness. One of the most frequently reported reasons for not working after SCI is inability to perform the physical demands of the job (60%). Herein, the authors discuss the vocational implications of impairments typical of SCI and strategies for managing these impairments so as to improve Veterans' outcomes in seeking and maintaining work after SCI.