Reduction of chronic aggressive behaviour 10 years after brain injury

This study demonstrates the successful management of aggressive behaviour w ith a client 10 years postinjury in a small, residential neurorehabilitatio n unit. The case presented is unusual for two main reasons. First, it prove d possible to significantly modify previously chronic challenging behaviour many years after brain injury had been sustained. Secondly, the rehabilita tion environment in which treatment was conducted did not comprise a highly specialized neurobehavioural service, Instead, staff were specifically tra ined regarding the administration of the treatment programme, which was bas ed on principles derived from behaviour modification and applied neuropsych ology. Specific interventions used included those of differential reinforce ment and graduated increase of expectations. Recordings made over the cours e of 85 weeks demonstrate a significant decrease in the frequency and sever ity 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 th e limitations inherent in attempting to manage aggression within neurorehab ilitation environments will be discussed.