Community integration after severe traumatic brain injury in adults

Department of Neurological Rehabilitation, Raymond Poincaré University Hospital, Garches, France.
Current opinion in neurology (Impact Factor: 5.31). 10/2010; 23(6):688-94. DOI: 10.1097/WCO.0b013e3283404258
Source: PubMed


Despite being the main cause of death and disability in young adults, traumatic brain injury (TBI) is a rather neglected epidemic. Community integration of persons with TBI was, until recently, insufficiently informed by clinical research.
To bridge the gap between rehabilitation and community re-entry, the first task is to assess the person, using TBI-specific outcome measures. The second task is to provide re-entry programs, the effectiveness of which is assessed by those measures, using well designed studies. There are very few such studies. However, there are some effective comprehensive programs and others which are specifically targeted dealing mainly with return to work, behavior, and family issues. The complex psychological and environmental components of the disability require individualized and often long-term care.
For persons with severe TBI trying to achieve the best possible community integration a new semiology is required, not just limited to medical care, but also involving social and psychological care that is tailored to the needs of each individual and family, living within his/her environment. Currently, only a minority benefit from well validated programs.

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Available from: Jean Luc Truelle, Feb 15, 2014
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    • "Medical treatment is becoming ever more advanced with ever-increasing numbers of survivors, rehabilitation programs are becoming more and more standardised [14] [30] [34] and the clinical factors correlated with RTW are better understood [2] [15] [17] [25] [26] [29] [39]. However, RTW rates remain quite low [10] [21] [28] [32] [35] [37]. In addition to rehabilitation, several types of vocational support have been proposed to facilitate RTW in TBI. "
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    ABSTRACT: To analyse usefulness of the SPASE programme, a coordinated facility programme to assist traumatic brain injury (TBI) persons in returning to work and retaining their job in the ordinary work environment. A retrospective study including 100 subjects aged over 18 who had suffered traumatic brain injury (GOS 1 or 2). The criterion for return to work (RTW) success was the ability to return to the job he/she had before the accident or to a new professional activity. Factors associated with RTW success were at short-term (2-3 years): the presence of significant workplace support OR=15.1 [3.7-61.7], the presence of physical disabilities OR=0.32 [0.12-0.87] or serious traumatic brain injury OR=0.22 [0.07-0.66]. At medium-term (over 3 years) these factors were: significant workplace support OR=3.9 [1.3-11.3] and presence of mental illness OR=0.15 [0.03-0.7]. This study suggests that a case coordination vocational programme may facilitate the return and maintain to work of TBI persons. It reveals that the workplace support is a key factor for job retention in the medium-term.
    Annals of physical and rehabilitation medicine 10/2013; 56(9-10). DOI:10.1016/
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    Revue Neurologique 04/2012; 168:A177-A178. DOI:10.1016/j.neurol.2012.01.459 · 0.66 Impact Factor
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    ABSTRACT: This qualitative study aimed to explore transitions from hospital to the home over a period of one year.Methods and procedures: A longitudinal, phenomenological approach was employed and 18 individuals with severe traumatic brain injury, their family members and rehabilitation professionals were interviewed using semistructured interviews, when the person with brain injury was discharged from the ward, after 6 months and again after one year.Results: Themes identified within the data included returning home, getting back to normal, moving forward and the role of rehabilitation in the transitional period. Further subthemes were also identified including issues of life-course disruption, self-identity, status and reconstruction.Conclusions: Data suggested that access to rehabilitation programs employing individualised, contextual interventions following discharge to the home were integral in enabling the transition through to autonomy and independence. Consideration of issues of identity and status can enable a different and potentially important perspective on the experience of transitions for those with brain injury. Reclaiming personal autonomy and control appeared to be central to the reconstruction of a coherent sense of self, enabling a meaningful life after brain injury.
    07/2012; 13(01). DOI:10.1017/BrImp.2012.3
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