METHODS AND INTENSITY OF HOLISTIC POST-ACUTE BRAIN INJURY REHABILITATION

Critical elements, specific methods, and outcomes of holistic post-acute brain injury rehabilitation are reviewed. Defining aspects of the holistic approach include: (1) a cognitive and behavioral approach, (2) emphasis on self-awareness, adjustment, compensation and social skills, (3) individualized goal setting, (4) group therapies within a therapeutic milieu, (5) transdisciplinary team specializing in brain injury rehabilitation, (6) low staff-topatient ratio, (7) family/ significant other involvement, (8) community-based vocational and independent living trials, and (9) systematic outcome assessment. In addition, more specific and evidence-based practices are typically included in a holistc treatment program. If initiated soon after initial hospitalization, the majority of people with moderate-severe brain injury can achieve rehabilitation goals and re-enter family and community life with the help of relatively limited and focused outpatient rehabilitation. A minority of patients, however, will require an intensive Comprehensive Day Treatment Program for successful rehabilitation. Severity of disability, self-awareness, chronicity, depression and substance abuse are among the factors that should be considered in making initial recommendations for the intensity and structure of post-acute rehabilitation. Of those patients who require intensive day treatment, about 70% sustain employment in the community with or without support. Of patients who are appropriately treated with a more limited and focus ed outpatient rehabilitation program, over 50% work in the community with complete independence and another 30% sustain community-based employment with support.