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Brain injuries can aect 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, difculty organizing and sequencing activities, and makingdecisions. Visual and auditory unctions can also be aected by a brain injury.In addition, ater a brain injury, many people experience a decrease in theirrustration 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 reinorced 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 warare that are not conduciveto perorming 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 saety-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 transer 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 oten 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 ater 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 cognitiveunctioning, 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.
1,2
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.
3
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 proessionals 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 perormance abilities relative to the demands o the activity. This perspective encompasses all aspects o anindividual’s lie, 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 lie settings such as the grocery store, bank, mall, bus/train, workplace, home, or any other environmentin which they need to regain competence in occupational perormance. Occupational therapy practitioners work as part o a team, which may include a physical therapist, speech-language pathologist, neuropsychologist, social worker, and otherproessionals 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
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