Community Integration Following Severe Traumatic Brain Injury: Outcomes and Best Practice

Abstract

Community integration is often cited as the ultimate aim of rehabilitation. However, outcome studies show that following severe traumatic brain injury (TBI), many people do not return to valued life roles or reach previous levels of integration within their community. More recent research, in association with extensive clinical experience, reveals significant variability in outcomes within this group. Although some people return to productive activity and maintain a network of family and friends, others lead lives characterised by boredom and loneliness. This paper has two aims. The first is to examine TBI community integration outcome literature and selected theoretical models. The second is to describe a Community Approach to Participation (CAP), an individualised and collaborative model of community-based practice, which endeavours to address the poor outcomes identified following TBI. The CAP will be illustrated in the detailed case study of Sarah.

Efficacy of leisure intervention groups in rehabilitation of people with an acquired brain injury

“…A significant behavioral deficit experienced by persons with ABI is often the decreased initiation of purposeful activity that may be especially important during leisure time (Davis & Chittum, 1994). There are several studies indicating that people with a brain injury are often unable to return to previous leisure activities and have fewer interests than they did prior to their injury (Brown & Vanderdergoot, 1998;Sloan, Winkler, & Callaway, 2004). People with a brain injury also tend to be involved in less physical and more passive recreation than previously, and it has been suggested that depression and fatigue play a role in this reduced involvement (Brown, Gordon, & Spielman, 2003).…”

Appraising evidence on community integration following brain injury: a systematic review

“…The priorities include the opportunity to obtain a residence, maintain a social support network and engage in productive activity. However, after traumatic brain injury many individuals are unable to attain a sense of belonging and high quality of life standards (Sloan et al, 2004;Minnes et al, 2003). In addition return to work is often cited as an objective indicator of CI even though many persons do not return to work.…”

“…disability, pathways of care, and outcomes (Abreu et al, 1996;Abreu and Peloquin, 2005;Doig et al, 2001;Heubner et al, 2003;Sloan et al, 2004). This adaptable rehabilitation process has been described by the type of facility and level of care provided ranging from intensive care units, where the person with brain injury is provided with life-sustaining medical care, to CI programmes generally focused on helping individuals participate fully within society (Abreu and Peloquin, 2005;Doig et al, 2001;Gutman, 1999).…”

Utility of the Canadian Occupational Performance Measure in community-based brain injury rehabilitation

“…The broad aim of community-based rehabilitation following acquired brain injury (ABI) is to maximize community integration and quality of life by facilitating greater independence, choice, opportunity and access to appropriate services for these individuals and their families [1][2][3]. The need for community-based services to enhance long-term outcomes has been highlighted by studies suggesting that psychosocial functioning may not improve and can even deteriorate over time [4,5].…”