Patients who engage in rehabilitation, whether it be community-based, in-home care, or residential transitional living programs, have all been found to experience improvements in productivity, social integration and activities of daily living (Hopman, Tate, & McCluskey, 2012). Goverover et al. (2007) found that an individual’s ability to perform instrumental activities of daily living (IADL) was stronger, and they had greater self-regulation, when self-awareness training was provided compared to conventional therapeutic interventions. In terms of improving an individual’s satisfaction with life, social relationships are important (Jacobsson & Lexell, 2013; Vandiver, 2000). The findings from Armengol (1999) suggest that social support groups which focus on education, coping skills training and goal setting result in positive changes in measures of hopelessness leading to a greater sense of control and empowerment. Social interaction through brain injury support groups can also provide individuals with a sense of belonging and reduce feelings of isolation. McLean, Jarus, Hubley, and Jongbloed (2012) studied patients at a brain injury drop-in center and found that over a third of patients’ social and leisure activities occurred there.
Learning productive coping mechanisms is also crucial. Individuals with TBI who used non-productive coping styles were found to have lower psychosocial functioning and increased anxiety. The former is concerning because the use of non-productive coping styles has been shown to increase to equal or higher levels than pre-injury (Gregorio, Gould, Spitz, van Heugten, & Ponsford, 2014). A study by Cicerone et al. (2008) found that participants in an intensive cognitive rehabilitation program which involved cognitive, emotional, interpersonal and functional interventions, had higher perceived quality of life scale scores than those receiving standard neurorehabilitation (p=0.0004).
Physical exercise and leisure activities should be encouraged during the rehabilitation process. A study by Driver, Rees, O'Connor, and Lox (2006) suggests that participation in group exercise should be encouraged as an adjunct of the rehabilitation process for patients with ABI as it can foster feelings of well-being and self-esteem which could have a positive impact upon other rehabilitation strategies (Driver et al., 2006). Any physical exercise is beneficial to patients post ABI, which has been reinforced by Schwandt et al. (2012) who demonstrated that aerobic exercises (ergometer, treadmill, or recumbent step machine) all lead to a reduction in depressive symptoms, improved self-esteem and improved aerobic capacity.
Life satisfaction following ABI seems to be directly related to employment and social integration (Corrigan, Bogner, Mysiw, Clinchot, & Fugate, 2001; Tennant, Macdermott, & Neary, 1995). This evidence demonstrates the importance of fostering the reintegration into meaningful, productive activity, which can be accomplished through vocational intervention. As suggested by the findings of Wall, Rosenthal, and Niemczura (1998), increased job success may be achieved through community based vocational training programs which combine the concepts of work adjustment and supported employment. Participants have shown to have increased employment success and satisfaction when techniques which foster self-confidence were used, instruction and adjustments were given for specific work tasks, and a job coach was available to minimize interpersonal problems (Wall et al., 1998).
Sexuality is also closely connected to an individual’s identity, relationships, and self-esteem (Moreno, Arango Lasprilla, Gan, & McKerral, 2013). Reduced self-esteem and a perceived decline in personal sex appeal have been reported as common personality changes following head injury (Kreuter, Dahllof, Gudjonsson, Sullivan, & Siosteen, 1998; Kreutzer & Zasler, 1989). Individuals who identified themselves as ‘impaired’ or inadequate in some way did not perceive themselves as confident or attractive and did not pursue or recognize safe opportunities for pair bonding or sexual activity. In approaching sexuality in a TBI population, a holistic perspective is necessary: neurophysiological and psychological effects, medical and physical issues, and relationship factors (Moreno et al., 2013). The complexity and interaction of these factors must be understood.
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