Why provide community support for persons with brain injury?

The papers by Schwartzberg and Schulz in this issue of AjOT were accepted for the March 1994 Special Issue on Brain InjUry Rehabilitation but could not be included because of space limitations. They are published here as a follow-up to that issue. Although it is recognized that persons with brain injury need continued services after discharge from the hospital, remarkably little empirical work has been published about community-based support services (Giles, 1994). Many long-term difficulties of the person with brain injury are associated with increased social isolation. Although functional skills are important in both patient and family view of rehabilitation outcome, the quality of patients' interpersonal relationships is also important (Tate, Lulham, Broe, Strettles, & Pfaff, 1989). Persons with brain injury are known to have difficulty maintaining preinjury social relationships and developing new friendships (Tate et aJ, 1989; Thomsen, 1984). Recent work has indicated that even persons without global intellectual impairment may demonstrate major social skills deficits (Spence, Godfrey, & Knight, 1993). Persons with brain injury show increased levels of social anxiety (Newton & Johnson, 1985) and may become increasingly discouraged about their ability to relate socially. Patients may be unemployed and their leisure interests may be poorly defined or nonexistent. As a result the social network of persons with brain injury may shrink, Greater social isolation may also be a factor in the greatly increased rate of psychiatric impairment and suicide among persons with brain injury (Achte, Hillbom, & Aalberg, 1969; Hillbom, 1960). Increased understanding of how socially skilled behaviors break down after brain injury may help in the development of more effective intervention strategies, Current evidence suggests that the Gordon Muir Giles