Recovery from acquired brain injury was widely thought to be complete at 6 months post-injury in the late 70’s and early 80’s. As survival rates improved for increasingly severe injuries, interest grew in challenging the 6-month recovery presumption. Hospital length of stay often exceeded 12 months and discharge options were limited to skilled nursing homes, psychiatric hospitals, jail, the street or to family homes. The strongest impetus for exploration of further recovery came from the workers compensation insurance sector due to the tremendous lifetime costs associated with care for individuals with ABI. Thus, the postacute community-based rehabilitation sector was born and has evolved over the last 40 years.

Dramatic changes in LOS in IRFs and increased awareness of rehabilitative potential after ABI combined as catalysts for this rehabilitation niche. These changes enabled identification of huge gaps in treatment availability with most patients receiving only minimal treatment due to persistent financial constraints to access.

This session will review the historic development of the field. Clinical and financial outcome efficacy will be reviewed. Limitations identified for postacute community-based rehabilitation will be discussed. Finally, the potential for this level of treatment as both vast and exciting will be presented.