13. Community Reintegration Following Acquired Brain Injury

Community reintegration is the ultimate goal of brain injury rehabilitation.  However, the evidence supporting many widely held beliefs about outcomes in this domain is limited.  The evaluation of clinical work in this domain may not lend itself well to the rigors of a randomized controlled trial, as the situations, circumstances, deficits, and supports are as complex and varied as the individuals themselves.

The transition back to the community from acute care or post-acute rehabilitation requires diverse supports in the community, often for extended periods of time.  Returning to a full range of activities within the community can prove difficult for brain injury survivors and their families.  Life encompasses work, love, and play, but rehabilitation efforts often focus primarily on vocational status. The impact of a brain injury on interpersonal relationships, parenting, friendships, and leisure roles may be equally and persistently disabling.

Given that a brain injury is a relatively significant disabler of an otherwise healthy, young, and productive segment of our population, the implications for return to productivity and “normalcy” becomes paramount. This is particularly poignant for those who were not yet able to live autonomously prior to the injury – in these cases, skill-focused rehabilitation must be founded on primary “habilitation”. Clients may need to be taught basic activities of daily living, how to make friends, and complete primary or secondary schooling before considering vocational options.