Transitions to independent living after ABI

Abstract

One of the most challenging questions facing service providers and policy makers alike is the appropriate level of supervision for adults living in the community following a brain injury. In a 3-year province-wide study of people entering the community following brain injury rehabilitation, four individuals (out of 22 studied) made a transition from fully supervised living to lower levels of formal supervision during their first year in the community. The present study seeks to provide more information about these four individuals, the factors that allowed them to move to lower levels of supervision, and the perceived success of that transition. For each participant, the interviews conducted over the 1 year period in the initial study were reviewed in detail for information about independent living. In addition, each participant was interviewed again for this study, along with his significant other and three of the community programme staff who were most closely involved with his transition. To summarize, factors most salient in the success of transition included: (1) Roles and relationships of family and programme personnel; (2) staying away from drugs and alcohol; (3) availability of structured daily activities, including productive activity or community programme; (4) financial management; and (5) emotion and behaviour self-control. Secondary themes related to successful community living also included the availability of transportation and prior experience with community living since the onset of brain injury. These results offer the experience of four individuals in moving towards independent living. As such, they provide a starting point for further discussions of the process of supporting individuals to pursue the ultimate goal of independent living.

Validation of the Activities of Community Transportation model for individuals with cognitive impairments

“…Conversely, the ability to return to driving following acquired brain injury has been associated with improved social outcomes: when able to return to driving, survivors report improved quality of life, greater social integration and greater ability to occupy their time productively when compared with non-drivers [1,4,7]. Individuals who are unable to drive typically either rely on care providers for rides or use public transportation [10].…”

“…autism, Down syndrome) or acquired (e.g. stroke, brain injury) conditions face numerous obstacles to independent community travel [1][2][3][4][5]. For example, limited communication ability, challenging behaviours and impaired cognition impact the navigation skills requisite for successful community navigation [2,3,6].…”

“…The ability to navigate in one's community is fundamental to community integration [1,2]. Unfortunately, individuals with significant cognitive impairments because of a variety of developmental (e.g.…”

How best to orient travellers with acquired brain injury: A comparison of three directional prompts

“…The ability to navigate in one's community is central to independence [25,26]. Identifying the most efficacious format for providing directions to people with navigational challenges resulting from ABI is important for increasing community participation.…”

Cost effective ways of facilitating home based rehabilitation and support

“…Thus, despite promising technological developments, solutions for the more complex problems of neurobehavioural disorder such as avolition, emotional regulation, disinhibition, impulsivity and social judgement are still incomplete or untested. Yet, evidence suggests that managing these issues is vital in ensuring a successful transition to community integration (McColl, Davies, Carlson, Johnston, Harrick et al, 1999). It is therefore imperative that the opportunity is not only taken to save costs but also to allow support work time to be focused on those core areas which technology cannot reach.…”