Neurobehavioural approaches to the rehabilitation of challenging behaviour.

Background: Neurobehavioural disability (NBD) following acquired brain injury undermines capacity for independent social behaviour and results in serious long-term social handicap. The presence of challenging behaviour as a feature of NBD has obvious implications for rehabilitation and community reintegration.

Objectives: Behavioural approaches are seen by many as fundamental to the successful rehabilitation of challenging behaviour. This paper will a) define the nature of neurobehavioural rehabilitation; b) explore the characteristics of cases referred, and c) the outcomes achieved. Strengths, limitations and future developments of neurobehavioural approaches for challenging behaviour will be considered along with potential factors that limit generalisation and longevity of treatment gains.

Methods: Literature review.

Results: Neurobehavioural services are distinguishable from other forms of neurorehabilitation. There is considerable evidence supporting the central role of both positive behaviour supports and contingency management approaches in creating conditions that minimise neurocognitive impairment, facilitate new learning, and ensure a positive social climate in both specialised inpatient units and community settings. Possible limitations include over-reliance on evidence from successful accounts of single cases and lack of knowledge regarding generalisation.

Conclusions: Neurobehavioural rehabilitation is effective and can save care costs in the long term. More evidence regarding maintenance of gains is required.