Comprehensive brain injury rehabilitation in post-hospital treatment settings

Abstract

The mission of comprehensive brain injury rehabilitation (CBIR) is to assist individuals with traumatic brain injury and their close others to resume full participation in family, work, and community life. In pursuing this goal, CBIR addresses the needs of participants holistically including cognitive and metacognitive impairments, neurobehavioral dysfunction, and interpersonal and affective issues, and identifies barriers and resources in their physical and social environments. Treatment is integrated and, in its most intensive form, relies heavily on developing a positive transdisci- plinary therapeutic milieu with an emphasis on group treatment. This chap- ter describes characteristics of participants best suited for CBIR and reviews interdisciplinary team evaluations and the operation and care of the rehabilitation team. Important components of CBIR include the development of a therapeutic milieu and therapeutic alliance, dynamic group treatment, cognitive rehabilitation, and interventions to address impaired self-aware- ness as well as co-morbid and premorbid conditions. This chapter describes how to provide these components in an integrated fashion in collaboration with close others and how to further integrate treatment with transitional interventions, such as, vocational rehabilitation, work and independent liv- ing trials, and resource facilitation. Methods for systematic measurement of progress and outcome both in the individual case and at a programmatic level are recommended in a continuous quality improvement model.