Rehabilitation after severe brain injury: a follow-up study of a behaviour modification approach.

Abstract

SUMMARY Twenty four patients with severe brain injury who had disturbed behaviours preventing rehabilitation or care in ordinary settings were treated in a token economy. This long-term follow-up study indicates that post-traumatic behaviour disorders can be lastingly improved, and that lengthy rehabilitation can have surprisingly good effects.A significant proportion of those who suffer severe head injury develop, as a more or less direct result of their injury, disorders of behaviour which impede or prevent physical, social and occupational rehabilitation. Often rehabilitation therapy staff are unable to cope with such patients, and find their demeanour and lack of motivation discouraging and frustrating, as well as frightening. Many such patients find their way to psychiatric, geriatric or mental handicap hospitals, where they are very out of place. The usual result is a lack both of rehabilitation and of treatment of the behaviour disorder. Often there is progressive worsening of the behaviour disorder.The nub of the problem is to find a way of managing behaviour which will produce cooperation and effort from the patient to allow therapists to apply their skills, and also allow the patient to learn the behavioural controls needed for him or her to become acceptable in the outside or "rear' world.Behaviour Modification (in a Token Economy setting) has been practised for many years with patients who show disorders of behaviour similar to those of the head-injured, though from different causes. ' The approach has been successfully applied in various clinical settings, and, to our knowledge, the only group of patients who have failed to gain long-term lasting benefit has been the chronic schizophrenic group. However, there seems to have been no previous attempt to apply the approach to the problem of the rehabilitation of head-injured patients with behaviour disorders.For the past five years, we have been involved in

Hysteria following brain injury.

“…Other psychiatric disorders 7 (35) 4 (12) 11 (20) 12 (13) 4 (17) 16 (14) Any psychiatric history 7 (35) 8 (24) 15 (28) 12 (13) 7 (29) 19 (17) Linked to injury 4 (20) 4 (12) 8 (15) 1 (1) 3 (13) 4 (4) Not linked 3 (15) 4 (12) 7 (13) 11 (12) 4 (17) 15 (13) history suggest a specific vulnerability; the male: female ratio of 0-6:1 also argues against this. There were a few patients in the H group in whom the clinical features clearly did derive from pre-existing personality disorder, but they were a very small minority.…”

Psychological stress, work satisfaction, and brain injury nursing

“…Traditional treatment of these head injured patients followed the medical model, so that while physical injuries were dealt with, little was done in the form of psychological, cognitive, or behavioral rehabilitation, with the consequence that many of the more severely impaired victims spent the rest of their lives in nursing homes. Recognition that behavior disorders following brain injury are quite common, and may inhibit rehabilitation (e.g., Eames & Wood, 1985), has led to the successful use of behavioral training to improve the quality of life of people with brain injuries, as measured by increased competence in activities of daily living and return to the community (Gloag, 1985).…”

Behavioral treatment of children after severe head injury: a pilot study

“…Interest in this field has grown considerably during the past twenty years and much experimental work has been done to increase the accuracy of evaluation of residual cognitive deficits and to identify the psychological sequelae of head injuries [20,21,14,42,5,7,34]. Varions'theories have been used to investigate the typical behaviors and the psychological treatment of post-traumatic syndromes [16,39,6,44,13]. It is now universally recognized that neurological damage due to head injury always gives rise to cognitive defttits and to typical behaviors both in children and in adults [12,8,28,15].…”