Community-based occupational therapy with a head-injured adult.

Editor's Note. To continue the Case Report department, we need and welcome reports that document the practice ofoccupational therapy for specific clinical situations. (Submit three copies ofyour manuscript to the Editor) Guidelines are available from the Editor. I n the early 1970s, the National Head Injury Foundation identified 422,000 adults with permanent brain damage caused by traumatic head injury. It is estimated that 400,000 new cases of varying severity are treated in hospitals each year, the majority of whom are previously employed young adult men. Although many persons with traumatic brain injuries are able to return to productivity, approximately 35% of the adults who have been rated as mildly head injured on the Glascow Coma Scale (Teasdale & Jennet, 1974) never return to work and have difficulty reentering society after restorative efforts are discontinued (Rosenthal, Griffith, Bond, & Miller, 1983). These persons often remain socially isolated and nonproductive and thus are likely to develop secondary occupational dysfunction. Adults with mild head injuries often report feeling incompetent, frustrated and struggle with a loss of control over their lives (Deutch and Sawyer, 1985). If they live at home, they frequently experience increased tension in the family; this tension can lead to the dissolution of the family unit and to the unnecessary institutionalization of the brain-damaged adult. The need for community-based intervention with a focus on culturally relevant occupational function is evident. This case report describes the progress of a mildly head-injured man who worked with an occupational therapist in a homebased program to improve occupational function.