Chapter 5: A Simply Self-Sustaining System, Community Based Reintegration Post Acute Brain Injury Program: A Promising Practice

The Simply Sustaining System is a promising community reintegration practice that serves survivors of acquired brain injury (ABI) with the philosophy of focusing on clients’ capacities as opposed to their deficits. The program is run predominantly in the rural areas of Riversdale in South Africa as an Adult Day Service Program. Dr. Alison Madden, the program founder, initiated the program after her experience in medical legal work after recognizing that there is a shortage of rehabilitation services that focus on community reintegration. This is especially the case after a person has left acute care in the period of hospitalization after a brain injury. Government care currently provides hospitalization during the acute phase of injury where medical treatment, neuro-surgery, and physical therapy are available. Occupational therapy and speech therapy are given only if the injured person has very obvious gait, upper limb, speech, and swallowing difficulties. The period of hospitalization is usually less than three weeks, with little transitional support for the person from the hospital to the home and community. Furthermore not only are survivors of ABI or traumatic brain injury (TBI) unable to receive services for their injuries, many also become highly passive, inactive, and lonely in their daily lives—disheartening characteristics that have been found in research among people with ABI (Ashley, Persel, & Krych, 1997 ; Dikmen, Machamer, & Temkin, 1993 ; Doig, Fleming, & Tooth, 2001 ). From an ethical and moral consideration of the circumstances of people with ABI, Alison wondered whether she could improve the anxiety and apathy that people with brain injury experience in order for them to take on tasks that have value to themselves and to their communities.