Shannon Janzen MSc, Pavlina Faltynek MSc, Andrea Lee, Corbin Lippert BScN, Joshua Wiener BSc, Magdalena Mirkowski MSc MScOT OT Reg.(Ont.), Robert Teasell MD FRCPC
Community reintegration is the ultimate goal of acquired brain injury (ABI) rehabilitation. However, the evidence supporting many widely held beliefs about outcomes in this domain is limited. The evaluation of clinical work in this area may not lend itself well to the rigors of a randomized controlled trial (RCT), as the circumstances, deficits, and supports are as complex and varied as the individuals themselves.
The transition back into the community from acute care or post-acute rehabilitation requires diverse supports within the community, often for extended periods of time. Returning to a full range of activities in the community can prove difficult for individuals post brain injury and their families. While life encompasses much more, rehabilitation efforts often focus primarily on vocational status. The impact of ABI on interpersonal relationships and leisure roles may be equally challenging.
Given that ABI is a relatively significant disabler of an otherwise healthy, young, and productive segment of the population, the implications for return to productivity and “normalcy” become 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”. Individuals may need to be taught basic activities of daily living (ADL), how to make friends, and complete primary or secondary schooling before considering vocational options.
This chapter will review the evidence pertaining to community integration, and is divided into five primary themes:
- Independence and Social Integration. This section deals with the ability to manage personal needs following ABI and looks at aspects of community reintegration including socialization, sexuality, and the role of community supports.
- Caregiving. This section deals with the issues of distress, depression, and burden that are experienced by caregivers of individuals with ABI.
- Life Satisfaction. This section includes those studies dealing with life satisfaction of individuals with ABI.
- Productivity. This section looks at educational and vocational activities, and vocational rehabilitation following ABI.
- Return to Driving. This section specifically deals with the return to driving following ABI.