Severe traumatic brain injuries (TBI) can occur across the lifespan but are especially common among young adults and can lead to lifelong disabilities. This chapter introduces a young man, Liam, who has experienced such a TBI leaving him with mild cognitive problems and some significant interpersonal difficulties after discharge from rehabilitation. Using Liam as an example, the prevalence, incidence, and neuropathology of severe TBI will be described, as well as some special issues with respect to rehabilitation. Remediation needs to be tailored to the recovery trajectory with different approaches at different times in the recovery process. Common problems with self-awareness, anxiety, depression, and fatigue can also interfere with motivation to engage in the rehabilitation process and need to be factored in when tailoring treatment. The chapter considers the use of restorative approaches and some of the constraints on this type of approach as well as occasions when more compensatory approaches may be better. In doing so, consideration is given to the current levels of evidence and practice guidelines that have recently been published. The chapter concludes with a brief discussion of potential areas of future treatment research and a consideration of the problems that beset rehabilitation research in this field.