Prolonged, severe behavioural disturbance following traumatic brain injury: What can be done

Abstract

At the end of 1994 the New South Wales Department of Health identified the need for a specialized unit for people with a brain injury who exhibited aggressive and violent behaviour at such a level that they could not be cared for in standard rehabilitation programmes and who were not mentally ill as defined by the Mental Health Act. An interim unit based on the principles of neurobehavioural rehabilitation was opened in the grounds of Lidcombe Hospital, and in January 1995 the first patient (SA) was admitted. Following intervention weekly aggression decreased from a peak of 159 incidents to zero after ten months. Other maladaptive behaviours also decreased markedly. Simultaneous attempts to improve adaptive behaviours were successful. At 11 months follow-up in the community, these gains were all noted to have been maintained. This article discusses the need for specialized units dealing with severe behavioural problems following head injury, presents the case of SA for illustrative purposes, and addresses some of the more common criticisms of such environments.

How do varied populations interact with embodied conversational agents? Findings from inner-city adolescents and prisoners

“…Mounting evidence suggests that integrity of ECF and its modulation of emotion may underlie variability in treatment responses and subsequent post-treatment outcomes (e.g., Aharonovich, et al, 2003). Clinical studies of head injuries, learning disabilities, and cognitive disorders demonstrate that ECF and related behavioral disorders are amenable to appropriately designed treatment (Hermann & Parente, 1996;Manchester, et al, 1997;Rothwell, et al, 1999;Wilson, 1997).…”

Evaluation of an Anger Management Therapy Programme Following Acquired Brain Injury: A Preliminary Study

“…These include token economy settings (Eames & Wood, 1985), time-out and positive reinforcement (Manchester, Hodgkinson, & Casey, 1997;Wood, 1987;Wood & Eames, 1981), and response cost Alderman & Ward, 1991). Such programmes are usually conducted within an inpatient rehabilitation setting, where there is a high degree of control over the patient's environment.…”

A forensic peer group approach to bullying after traumatic brain injury

“…In young persons with frontal brain injury estimates of violence are as high as 60% with 11% being physically violent (Grafman et al, 1996). While aggressive behaviour can be similar across individuals with brain injury its aetiology can be manifestly different (Manchester, Hodgkinson, & Casey, 1997a) This is because the same behaviour can result from a complex interplay of organic, environmental and personality/psychological factors that will vary from person to person (see Alderman 2004, for a full description of contributory factors). In addition, identical behaviours can serve very different functions for different persons (Sturmey, 1996).…”