The Impact of Intensive Community Based Rehabilitation on Community Participation and Life Satisfaction Following Severe Traumatic Brain Injury

Abstract

Brain injury represents the leading cause of death and disability worldwide (International Brain Injury Association [IBIA], 2011). While a small percentage of traumatic brain injury (TBI) survivors continue in a persistent state of coma, the vast majority return to the community with some residual cognitive, psychosocial, behavioral, or physical impairment (Kersel et al., 2001). These impairments contribute to a dramatic change in the individual’s life course, profound disruption of the family, enormous loss of income or earning potential and large expenses over a lifetime (McKinlay and Watkiss, 2001). The need for effective post-acute rehabilitation for traumatic brain injuries has emerged out of both the limited effectiveness of inpatient models (Department of Health and Human Services [DHHS], 2001) and health care system changes that support reduced average length of inpatient stay (Canadian Institute for Health Information, 2008). Within a traditional inpatient model, interventions generally center around medications, surgery, and therapeutic exercises / activities. While this approach is recognized as a necessary component of TBI treatment, it has been argued that by fostering the ‘patient’ role, the inpatient setting has been inadequate for facilitating improvement in important life roles (Willer, et al., 1992). Roles such as parent, spouse, student, employee, and friend are considered essential to successful and satisfying performance in community settings yet are rarely specifically addressed in traditional brain injury rehabilitation models. Determining what constitutes “successful” rehabilitation following traumatic brain injury has received considerable attention among brain injury clinicians and researchers. Many researchers view community integration as the goal of rehabilitation professionals and the rehabilitation programs (Doig, et al., 2001; McColl, et al., 1998). Successful community integration has been described as settling clients into communities where they are both happy and productive (McColl et al., 1998). Life satisfaction has also been considered an important health indicator and measure of rehabilitation outcome (Department of Health and Human Services [DHHS], 2001).