ObjectivesThe study describes functional outcomes and health‐related quality of life (HRQL) in patients with traumatic brain injury (TBI) 20 years postinjury.Materials and MethodsForty‐four survivors who acquired moderate and severe TBI during 1995–1996 were followed 10 and 20 years postinjury. Outcomes were Glasgow Outcome Scale Extended (GOSE), Community Integration Questionnaire (CIQ), and SF‐36 questionnaire (SF‐36). Multiple regressions were performed to examine the relationship between follow‐up measurements, controlling for baseline demographics and injury severity.ResultsThere were no significant differences in baseline age and civil status between moderate and severe TBI, but patients with severe injury had significantly lower employment rates (p = 0.05). Mean age at 20‐years follow‐up was 50.8 (SD 11.4) years, and 73% were males. Most patients showed good recovery (52%) or moderate disability (43%). Disability levels remained stable between and within severity groups from 10 to 20 years. Community integration including social integration improved from 10 to 20 years (p = 0.01 and p = 0.005, respectively). HRQL remained stable, except for subscales Bodily Pain and Role Emotional (p = 0.02 and p = 0.06). Depression at 10 years and females were associated with poorer mental health, while productive activity at 10 years indicated better physical and mental health at 20 years postinjury, respectively.ConclusionsFunctional limitations persist even decades after moderate and severe TBI, with poorer prognosis for females and persons who were depressed at the 10‐year follow‐up. Development and evaluation of targeted long‐term follow‐up programs and access to rehabilitation services for these groups should be highlighted. Improved community integration despite stable functional limitations draws attention to long‐term adaptation to adversity and illness.

resumen: Antecedentes: los alumnos con discapacidad intelectual precisan de buenas prácticas de evaluación e intervención desde enfoques holísticos para garantizar su derecho a la educación inclusiva. Estas prácticas se ordenan por la legislación educativa la regulación de la inclusión educativa del alumnado con discapacidad intelectual: una reforma pendiente m. á. verdugo, a. m. amor, m. fernández, p. navas e i. calvo

Although inclusive education has evolved from a general principle to a recognized right, a quality inclusive education is still not a reality for students with intellectual disability. In this article, we discuss three approaches that can bridge the gap between “what is” current education of these students and “what should be”. First, we address the underpinnings of Article 24 of the United Nation’s Convention on the Rights of Persons with Disabilities a nd its i mplication for educational systems concerning placement and goals to achieve in these students. Second, we provide a general overview of the supports paradigm and its conceptual and practical implications regarding inclusive education. Third, we present a quality of life model as a value-based and evidence-driven framework to enhance inclusive opportunities in students with intellectual disability and to support decision-making in education from a “whole child approach”. Finally, we provide a comprehensive, systematic framework that brings these three approaches together to improve students’ outcomes linked to the goals of access, participation, learning, and development.

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