Brain injuries can aect motor, sensory, cognitive, and behavioral unctioning. Aperson who has sustained a brain injury may fnd it challenging to return to workor school, or engage in many o the other activities that he or she enjoyed priorto the injury. Individuals may also have decreased balance and coordination,memory impairments, difculty organizing and sequencing activities, and makingdecisions. Visual and auditory unctions can also be aected by a brain injury.In addition, ater a brain injury, many people experience a decrease in theirrustration tolerance and an increase in impulsive behaviors.As a result o the U.S. engagement in two combat ronts, the high number o wounded warriors with traumatic brain injuries (TBIs) who are attempting toreintegrate into the community has highlighted and reinorced an even greaterneed to address the long-term unctional status o individuals with this condition. Those who have served in the militarymay exhibit posttraumatic stress disorder and other vestiges o their survival training or warare that are not conduciveto perorming daily activities in a regular home or work environment. For example, wounded warriors may need torelearn how to drive in a noncombative way (contrary to their saety-oriented training on the battlefeld) or address angermanagement issues with their amilies and others. Ultimately, regardless o where or how the individual sustained a TBI,there is a need to transer skills learned in a rehabilitation setting to natural environments such as the home, workplace,and recreational settings so he or she can resume participation and unction as close to prior levels as possible.Rehabilitation oten begins in the hospital environment. The ocus in this early stage o recovery is typically on regainingphysical, sel-care, and general cognitive skills; however, many people with moderate or severe brain injuries will needongoing rehabilitation to regain optimal unction ater they are discharged rom a medical acility. Community-basedrehabilitation is part o the continuum o care that assists individuals in regaining these skills. Community-basedrehabilitation ocuses on improving the acquisition and application o skills in the areas o physical and cognitiveunctioning, mobility, social integration, productivity, perception o sel, interpersonal relationships, and independentliving skills in natural environments where they are used in daily activities.Individuals with brain injuries who participate in community-based rehabilitation have improved outcomes in physicaland cognitive abilities, adjustment, and participation in the community.
The National Institutes o Health
Consensus Development Conference Statement on Rehabilitation of Persons with Traumatic Brain Injury
recommended that community-based services be included in extended care and rehabilitation.
They also recognized that individuals with brain injuriesmay beneft rom modifcation o their home and social and work environments to enable ull community participation.
The Role of Occupational Therapy
Occupational therapy practitioners are key rehabilitation proessionals in assisting individuals with brain injury toreintegrate back into the community. Their education and training make them experts at evaluation and analysis o anindividual’s perormance abilities relative to the demands o the activity. This perspective encompasses all aspects o anindividual’s lie, including activities o daily living (e.g., sel-care) and instrumental activities o daily living (e.g., homemanagement, rest and sleep habits, work demands, play, leisure, social participation). They can then help clients relearnhow to do these activities (remediate) or determine new ways o accomplishing them (compensatory strategies). Throughguided, graded instruction within the context o the client’s community, occupational therapy practitioners may work withindividuals in real lie settings such as the grocery store, bank, mall, bus/train, workplace, home, or any other environmentin which they need to regain competence in occupational perormance. Occupational therapy practitioners work as part o a team, which may include a physical therapist, speech-language pathologist, neuropsychologist, social worker, and otherproessionals as appropriate, such as teachers or vocational rehabilitation counselors.
Occupational Therapy and
Community Reintegrationof Persons With Brain Injury
www.aota.org4720 Montgomery Lane, Bethesda, MD 20814-3425Phone: 301-652-2682 TDD: 800-377-8555 Fax: 301-652-7711