Vocational Training for individuals with Cerebral Palsy

 

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Employment as Indicator of Successful Rehabilitation

Economic independence and social integration are themes that rank highly among people with Cerebral Palsy as long-term objectives for rehabilitation. Young people with Cerebral Palsy who are currently enrolled in school rank getting a job as top priority and adults with Cerebral Palsy list work and independent economic life as two of the most important life domains related to health & well-being [1]. Employment is very often the way in which individuals define themselves in society and are an important means of participating in society. As life expectancy and functional capacity of people with Cerebral Palsy increases, so does the need for inclusion into the workforce.

Improved participation is often the philosophical long term goal of rehabilitation not only for people with Cerebral Palsy but also for many health professionals who work with them. To work towards this aim, it is therefore important for health professionals to be aware of the facilitators and barriers faced by people with Cerebral Palsy to participate actively in the workforce and to provide appropriate support to strive towards economic independence and social integration.

Employment in Cerebral Palsy

The employment rate of adults with Cerebral Palsy is difficult to determine and depends highly on the context wherein an individual resides. Participation in competitive employment ranges from 21% to 56% and for sheltered or non-competitive employment it ranges from 5% to 18% [3].

Table 1 presents the results from a population-based research in Denmark indicating an employment rate for the general population around 82% competitively employed whereas for Cerebral Palsy this averages to only 29%, with individuals with hemiplegia the highest enrolment in competitive employment (46%). It is important to recognize that only half of the persons with Cerebral Palsy who attended normal schooling managed to get a job which should be of specific concern [3].

Table 1: Employment status (%) among individuals 21-35 years old with Cerebral Palsy according to clinical subtype of Cerebral Palsy and compared with controls. Source: Michelsen, S. I., Uldall, P., Kejs, A. M. T., & Madsen, M. (2005). Education and employment prospects in cerebral palsy. Developmental Medicine & Child Neurology, 47(8), 511-517.Facilitators and Barriers to Employment in Individuals with Cerebral Palsy
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Educational achievement and cognition are seen to be the most significant factors that can influence employment outcome with the level of education, especially education beyond high school, being an important determinant of social participation and functioning [1,2]. Unfortunately, acquiring an education is often difficult for persons with CP because of physical limitations as well as the possible presence of learning and communication problems. This is even more so in Low Income Countries where the inability to attend school can result in enormous socioeconomic consequences. Currently most efforts for rehabilitation often focus on the physical; however, the importance of cognition in later employability should be emphasized further. Furthermore, individuals with CP often experience problems with social interaction with young people with CP less socially active than young people without disability, and individuals with disabilities become increasingly socially isolated with age. The opposite applies to individuals without disability, who become more socially active after school age [2].

The physical should however not be ignored as especially community mobility, higher level of self-care and more independence are all positively related with employment [2]. Home support programs, legal mandates, social attitudes, family support, environmental access and increasingly the access to computer technology and communication devices can significantly alter ones opportunities for employment [3, 4].

Finally it should be noted that there might be work disincentives at play when governments provide disability benefits, this when advancement in work might cause financial loss through termination of these financial benefits. It is often seen that individuals receiving disability-related benefits are less likely to obtain employment, however this is probably related to functional severity and is thus not necessarily causal. Nevertheless, when implementing disability programs it should be done with caution not to exacerbate the possible adverse effects of financial benefits on employment [1]

Types of Employment Performed by Adults with Cerebral Palsy

There is not a single sector where adults with Cerebral Palsy are generally employed, and this should definitely be dependent on the individual needs and possibilities. Nevertheless, a study in Denmark [3] found the five largest sectors where adults with Cerebral Palsy worked included Health and Social Services; Commerce; real estate, leasing and business services; Manufacturing; and Public Administration, Armed Forces and Social insurance.

In addition to inclusion in competitive employment, some adults with Cerebral Palsy are able to enter programs of non-competitive employment. Non-competitive employment can broadly be categorized in two groups:

• Flexible working arrangements; employees work less than fulltime and the workplace pays attention to special needs. Employees receive a standard wage but the employer receives wage subsidies.
• Sheltered Employment; individuals with little ability to work can be given a wage and employer receives wage subsidies.
  
  

References

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