An estimated 1.7 million sustained traumatic brain injuries (TBIs) are documented in the United States each year, with many incidences going unreported (Faul, Xu, Wald, & Coronado, 2010; Selassie et al., 2008). Approximately 3.2 million Americans need long-term and lifelong assistance to perform activities of daily life as a result of sustaining a TBI (Corrigan, Selassie, Langlois-Orman, Kreutzer, & Arango-Lasprilla, 2010). Many health professionals and social workers inclusive of, but not limited to, rehabilitation counselors, occupational therapists, speech pathologists, and neuropsychologists will likely work with persons recovering from a TBI during their careers.
TBI is often referred to as a "silent epidemic," impacting many, yet oftentimes going unseen or misunderstood by professionals (Degeneffe et al., 2008). The onset of a TBI solicits coping and adjustment from both the individual, as well as family members to process and adapt to the injury (Groomes & Linkowski, 2007). Because of the nature of its sudden onset and progression, a TBI can result in higher demands being placed on both the individual and family members during the adjustment-todisability process than other types of acquired disabilities (Serio, Kreutzer, & Witol, 1997). Furthermore, it results in family members needing to assist the individual with TBI with activities of daily life as well as changes in their family roles and related responsibilities.
Individuals who sustain a TBI face a myriad of challenges across home, school, family, and employment arenas (Sander, Clark, & Pappadis, 2010). Although long-term consequences of TBI include premature death, dementia, and unprovoked seizures, short-term consequences such as depression, aggression, social isolation, and heightened dependence immediately impact the family members and caregivers (Rutherford & Corrigan, 2009). High unemployment rates resulting from a TBI create financial dependence on family members (Struchen, Atchison, Roebuck, Caroselli, & Sander, 2002). Resuming responsibilities and achieving societal productivity and functional independence is difficult for persons with TBI (Griffen, Hanks, & Meachen, 2010). Because of the cognitive impact TBI has on a person's ability to process information and perform activities at a level consistent with functioning prior to injury, most often this disability requires a comprehensive treatment plan inclusive of inpatient and outpatient therapy. Sequelae of TBI often include physical, emotional, psychological, and psychosocial ramifications that are further complicated by limited access to educational materials, financial, and social resources and supports for both individuals with TBI and their families (C. Dillahunt- Aspillaga & Monroe, 2012).
Postrehabilitation, successful community reintegration is of emerging importance to the TBI population. There is a large body of literature documenting "impairments in multiple aspects of community integration following TBI, including independence in household activities, parenting, community mobility, vocational functioning, and development and maintenance of friendships and intimate relationships" (as cited in Sander et al., 2010, p. 121). The task of defining and assessing community integration is complex and there does not "seem to be a single, universally accepted definition for this construct" (Salter, Foley, Jutai, Bayley, & Teasell, 2008, p. 820). According to Corrigan (1994), community integration is defined as "the assumption or resumption of culturally and developmentally appropriate social roles following disability" (as cited in Sander et al., 2010, p. 123). Community reintegration is the process of adjustment in social and workrelated activities after sustaining a life-changing and disabling event. In addition, the definition of community reintegration should include emphasis on social activities and relationships in addition to employment and independent living (Sander et al., 2010). The experience varies for individuals based on the level of changes in their individual functioning and activities postinjury (Wade, Drotar, Taylor, & Stancin, 1995). Successful community reintegration increases quality of life and consequently impacts all areas of rehabilitation such as employment, health, productivity, and independent living (Winkler, Unsworth, & Sloan, 2006). Success can enhance personal autonomy and increase success in other areas of the rehabilitation process (Ponsford, Olver, & Curran, 1995).
Julianne Frain, PhD, CRC, ABVE, is a Vocational Rehabilitation Consultant who provides quality expert vocational services. Since 2008, Dr. Frain has worked with hundreds of claimants, giving expert advice on wage-loss and re-employment issues.
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