Community integration after TBI is an important step in recovery

By Rebecca LaBo, Recreational Therapy Intern
Rainbow Rehabilitation Centers

By nature, people are very social creatures and have an ingrained need to feel that they are part of a community. A traumatic brain injury (TBI) is more than a physical injury—it can also affect a person’s self-esteem and self-worth. Becoming a part of an individual’s community again after a TBI is an important step in the healing process. Knowing how to get around and use community resources are tasks the person may need to reacquaint themselves with or even relearn.

Exploring the Community is one of the many community integration groups offered at Rainbow. Led by Recreational Therapist Nancy Miller, CTRS, the group is currently offered two afternoons per week at various locations near the Ypsilanti Treatment Center in the Ypsilanti/Ann Arbor, MI surrounding communities.

What is community integration?

Community integration trains the individual to use memory and compensatory techniques such as daily planners, electronic devices, checklists, and cueing systems to interact in a community setting. It also assists in developing effective schedules and routines while instructing the individual and family members in techniques to cope with changes in behavior and low frustration tolerance with multiple stimulations received in a community setting. This therapeutic intervention is designed to enable their personal, social and vocational competency so they can live successfully in the community.

In relation to rehabilitation, community integration holds a high importance within the recovery process. This type of activity generally focuses on developing higher level motor, social, and cognitive skills in order to prepare the person with a brain injury to return to independent living and potentially to work. Treatment may focus on safety in the community, interacting with others, initiation and goal setting, and money management skills.(1)

Community integration is indeed a therapeutic approach and in the case of this particular group, it is led by a Certified Therapeutic Recreation Specialist (CTRS). The therapist’s role while implementing this approach is to provide various activities to improve and enhance self-esteem, social skills, motor skills, coordination, endurance, cognitive skills, and leisure skills. The therapist can plan community outings to allow the person to directly apply learned skills in the community, such as shopping or going to the mall, among other activities. Additional activities provided by recreational therapists for community integration may include pet therapy, leisure education, wheelchair sports, gardening, and special social or holiday functions for clients and their family.(1) There are a wide variety of activities that can be provided under community integration.

What does the Exploring the Community group do?

At the beginning of each month on their designated day of the week, group participants meet with the therapist at a restaurant of their choosing. The group discusses and plans for the following month’s activities. Each participant is required to come up with one outing for which they will be the “group leader.” By having each participant come up with an activity, their interests are being represented within the group.

Also, the therapist and participants go over their individual goals they wish to maintain and strive to obtain. Members discuss their progression on reaching their goal. This provides a healthy conversation and keeps the group on track. If a goal has been reached, a new goal will be devised.

Each week, the group leader has the task of meeting with the therapists to plan the outing. This may require a phone call to the location to gather information or checking online. While on the outing, the group leader is in charge of directing the group and explaining their activity for that day.

The Exploring the Community group at Rainbow has proven to be very popular and the members especially enjoy being able to give input into the planning of the various activities and outings. As a result, many have shown a higher level of self-confidence due to their participation in this fun and active rehabilitation group.


The benefits of the Exploring the Community groups:

Greater quality of life
Increased independence
Skill development
Community involvement
Exploring community resources
Increase in socialization skills
Volunteer placement
Movement to employment

Some of the locations that the Exploring the Community groups have visited:

Briarwood Mall in Ann Arbor
Trentwood Farm for fishing
The Yankee Air Museum at the famous Willow Run Airport in Belleville
U of M’s Planetarium in Ann Arbor
The Five & Below store in Ann Arbor
Salvation Army in Ann Arbor
Greektown in Detroit
Mexican Town in Detroit
The Hudson Car Museum in Ypsilanti
Depot Town in Ypsilanti
Gallup Park in Ann Arbor
Movie theaters

Lisa Helzer and Nikki Markham enjoy lunch and activity planning

Lisa Helzer and Nikki Markham enjoy lunch and activity planning


 icki Bradley and Recreational Therapist Nancy Miller take a relaxing cruise around the lake

Vicki Bradley and Recreational Therapist Nancy Miller take a relaxing cruise around the lake


  1. Brain Injury treatment – Brain Injury Association of America. (2015). Retrieved August 25, 2016