Reduction of chronic aggressive behaviour 10 years after brain injury

Abstract

This study demonstrates the successful management of aggressive behaviour with a client 10 years post-injury in a small, residential neurorehabilitation unit. The case presented is unusual for two main reasons. First, it proved possible to significantly modify previously chronic challenging behaviour many years after brain injury had been sustained. Secondly, the rehabilitation environment in which treatment was conducted did not comprise a highly specialized neurobehavioural service, Instead, staff were specifically trained regarding the administration of the treatment programme, which was based on principles derived from behaviour modification and applied neuropsychology. Specific interventions used included those of differential reinforcement and graduated increase of expectations. Recordings made over the course of 85 weeks demonstrate a significant decrease in the frequency and severity of aggression. Successful inhibition of challenging behaviour attained a level which facilitated transfer of the client to a non-institutionalized community home. Reasons underlying the success of the intervention, and the limitations inherent in attempting to manage aggression within neurorehabilitation environments will be discussed.

Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury

“…Wood, McCrea, Wood, and Merriman (1999) found that neurobehavioural rehabilitation still produced positive changes in patients more than 5 years post-injury although the changes were not as great as for those receiving rehabilitation sooner after injury. Watson, Rutterford, Shortland, Williamson, and Alderman (2001) describe a single case which suggests that positive changes in behaviour can be achieved more than 10 years post-injury, given a lengthy period of input. Furthermore this was established with a minimum of professional staff.…”

Community neurorehabilitation: A synthesis of current evidence and future research directions

“…8 Third, it supplies periodic, maintenance rehabilitation for individuals with chronic, progressive neurological disorders, but who again, do not require hospitalization. 9 This growing field is grounded in a belief in the importance of on-going rehabilitation for neurological illness; i.e., that neurorehabilitation can be beneficial even years after an injury or illness event 10 and that long-term and recurrent rehabilitation may help individuals maintain or advance their functional status. 11,12 It is further argued that such community maintenance rehabilitation does not require the intensive and expensive care of an acute, inpatient hospital, but rather, specialized rehabilitation can be provided on an outpatient basis.…”

Aggression after paediatric traumatic brain injury: A theoretical approach

“…social behaviours) are emerging [5]. In general, TBI has been associated with cognitive [6], academic [7] and behavioural impairments [8]. Of these sequelae, behavioural impairments have been reported to be most persistent over time and of great concern.…”