A pilot study was performed to assess the value of aerobic training as part of the rehabilitation programme for patients with a single incident brain injury requiring admission to an inpatient neurological rehabilitation unit. The cohort consisted of six patients with a combination of impairments including weakness, spasticity, taxia and cognitive problems. Each patient performed an exercise test at the beginning and end of the study to assess changes in aerobic fitness and performance. The aerobic training programme consisted of 20-30 minute sessions on an exercise bike three times a week for eight to 12 weeks. The post-training exercise test showed significant increases in duration ( p < 0.01) and in workload ( p < 0.025) compared to the pretraining test. There were no adverse effects from the training programme. Aerobic training should be considered in the rehabilitation programmes devised for patients with recent brain injury. Further research is needed to determine the best way to integrate this with other aspects of rehabilitation.

Violent and sexually disinhibited behaviour together with poor self-care developed in a 38-year-old teacher following herpes simplex encephalitis. These behaviours were sufficiently severe to make rehabilitation difficult and return to the community impossible. Initially, only violent behaviour was treated, both by medication and a behaviour programme, and sexual disinhibition subsequently by the latter. In order to implement the programme a special (psychiatric) nurse was required on a 24 h basis. The incidence of violent behaviour was reduced from up to 55 times per day to zero over a period of 2 months. Whether this was affected by medication or behaviour management, or by spontaneous recovery, is discussed. Sexual disinhibition was eliminated in supervised settings, but continued to occur if left unsupervised and this improvement resulted from behaviour management. Poor personal hygiene also improved markedly over the 6-month period. The goal of returning the patient home to live with her family was achieved and she remained there at follow-up. This intervention was carried out in a rehabilitation unit that does not specialize in the treatment of such cases; clearly this has implications for cost and quality of care.

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