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Rehabilitation Approaches to the Management of Aggressive Behaviour Disorders after Acquired Brain Injury

Published online by Cambridge University Press:  14 May 2013

Nick Alderman ,
Caroline Knight  and
Jennifer Brooks
Nick Alderman*
Affiliation:
Brain Injury Services, Partnerships in Care, Grafton Manor, Grafton Regis, UK Brain Injury Research Group, College of Human and Health Science, Swansea University, Swansea, Wales
Caroline Knight
Affiliation:
National Brain Injury Centre, St Andrew's Healthcare, Billing Road, Northampton, UK Kings College London, St Andrew's Academic Centre, Northampton, UK
Jennifer Brooks
Affiliation:
National Brain Injury Centre, St Andrew's Healthcare, Billing Road, Northampton, UK
*
Address for correspondence: Professor Nick Alderman, Brain Injury Services, Partnerships in Care, Grafton Manor, Grafton Regis, Northampton NN12 7SS, UK. E-mail: N.Alderman@swansea.ac.uk
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Abstract

Symptoms of neurobehavioural disability acquired through brain injury, especially aggression, are associated with severe social handicap. Differences in terminology have resulted in varying estimates, but aggressive behaviour disorder appears to be characteristic of survivors at some point in their recovery journey. This paper provides a brief review regarding the prevalence, development and causes of aggression associated with acquired brain injury (ABI), and what can be done to help manage them. The advantages of using standardised measures conceptualised for ABI in the assessment and formulation of aggressive behaviour disorders are especially highlighted. A range of treatment methods and the evidence base relating to these are described. The contribution of pharmacological therapies, cognitive behavioural therapy and behavioural interventions are explored. It is argued that the strongest evidence base is associated with behaviour therapy, especially when carried out in the context of neurobehavioural rehabilitation, and two case studies are described to illustrate the clinical advantages of interventions derived from operant theory. Comparative lack of ABI experts trained in the management of post-acute behaviour disorders remains a limiting factor.

Keywords

acquired brain injuryneurobehavioural disabilityaggressiontreatmentrehabilitation
Type
State of the Art Reviews
Information
Brain Impairment , Volume 14 , Issue 1: State of the art reviews in mental health after traumatic brain injury , May 2013 , pp. 5 - 20
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 

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References

Alderman, N. (2001). Management of challenging behaviour. In Wood, R.Ll. & McMillan, T. (Eds.), Neurobehavioural disability and social handicap following traumatic brain injury. Hove: Psychology Press.Google Scholar
Alderman, N. (2002). Individual case studies. In Priebe, S. & Slade, M. (Eds.), Evidence in mental health care. Hove: Brunner-Routledge.Google Scholar
Alderman, N. (2003). Contemporary approaches to the management of irritability and aggression following traumatic brain injury. Neuropsychological Rehabilitation, 13, 211–240.CrossRefGoogle Scholar
Alderman, N. (2004). Disorders of behaviour. In Ponsford, J. (Ed.), Rehabilitation of neurobehavioural disorders. New York: The Guilford Press.Google Scholar
Alderman, N. (2007). Prevalence, characteristics and causes of aggressive behaviour observed within a neurobehavioural rehabilitation service: predictors and implications for management. Brain Injury, 21, 891–911.CrossRefGoogle ScholarPubMed
Alderman, N. (in press). Acquired brain injury, trauma and aggression. In Dickens, G., Picchioni, M. & Sugarman, P. (Eds.), The handbook of specialist secure inpatient mental health care. London: Royal College of Psychiatrists Publications.Google Scholar
Alderman, N., Davies, J.A., Jones, C., & McDonnell, P. (1999). Reduction of severe aggressive behaviour in acquired brain injury: case studies illustrating clinical use of the OAS-MNR in the management of challenging behaviours. Brain Injury, 13, 669–704.Google ScholarPubMed
Alderman, N., Fry, R.K., & Youngson, H.A. (1995). Improvement of self-monitoring skills, reduction of behaviour disturbance and the dysexecutive syndrome: comparison of response cost and a new programme of self‑monitoring training. Neuropsychological Rehabilitation, 5, 193–221.CrossRefGoogle Scholar
Alderman, N., & Groucott, L. (2012). Measurement of social climate within neurobehavioural rehabilitation services using the EssenCES. Neuropsychological Rehabilitation, 22, 768–793.CrossRefGoogle ScholarPubMed
Alderman, N., & Knight, C. (1997). The effectiveness of DRL in the management and treatment of severe behaviour disorders following brain injury. Brain Injury, 11, 79–101.CrossRefGoogle ScholarPubMed
Alderman, N., Knight, C., & Morgan, C. (1997). Use of a modified version of the Overt Aggression Scale in the measurement and assessment of aggressive behaviours following brain injury. Brain Injury, 11, 503–523.CrossRefGoogle ScholarPubMed
Alderman, N., Wood, R.Ll., & Williams, C. (2011). The development of the St Andrew's–Swansea Neurobehavioural Outcome Scale: validity and reliability of a new measure of neurobehavioural disability and social handicap. Brain Injury, 25, 83–100.CrossRefGoogle ScholarPubMed
Arundine, A., Bradbury, C.L., Dupuis, K., Dawson, D.R., Ruttan, L.A., & Green, R.E. (2012). Cognitive behavior therapy after acquired brain injury: maintenance of therapeutic benefits at 6 months post-treatment. Journal of Head Trauma Rehabilitation, 27, 104–112.CrossRefGoogle Scholar
Baguley, I.J., Cooper, J., & Felmingham, K. (2006). Aggressive behaviour following traumatic brain injury: how common is common? Journal of Head Trauma Rehabilitation, 21, 45–56.CrossRefGoogle ScholarPubMed
Bradbury, K.E., & Clarke, I. (2007). Cognitive behavioural therapy for anger management: effectiveness in adult mental health services. Behavioural and Cognitive Psychotherapy, 35, 201–208.CrossRefGoogle Scholar
Brooks, D.N., McKinlay, W., Symington, C., Beattie, A., & Campsie, L. (1987). The effects of severe head injury upon patient and relative within seven years of injury. Journal of Head Trauma Rehabilitation, 2, 1–13.CrossRefGoogle Scholar
Buchanan, T.W., Tranel, D., & Adolphs, R. (2006). Impaired memory retrieval correlates with individual differences in cortisol response but not autonomic response. Learning and Memory, 13, 382–387.CrossRefGoogle Scholar
Burke, H.H., Wesolowski, M.D., & Lane, I. (1988). A positive approach to the treatment of aggressive brain injured clients. International Journal of Rehabilitation Research, 11, 235–241.CrossRefGoogle Scholar
Cattellani, R., Zettin, M., & Zoccolotti, P. (2010). Rehabilitation treatments for adults with behavioural and psychosocial disorders following acquired brain injury: a systematic review. Neuropsychological Review, 20, 52–85.CrossRefGoogle Scholar
Crane, A.A., & Joyce, B.G. (1991). Brief report: Cool down: a procedure for decreasing aggression in adults with traumatic head injury. Behavioural Residential Treatment, 6, 65–75.Google Scholar
Demark, J., & Gemeinhardt, M. (2002). Anger and its management for survivors of acquired brain injury. Brain Injury, 16, 91–108.CrossRefGoogle ScholarPubMed
Ducharme, J.M., & Harris, K.E. (2005). Errorless embedding for children with on-task and conduct difficulties: Rapport based, success focussed intervention in the classroom. Behavior Therapy, 36, 213–222.CrossRefGoogle Scholar
Dyer, K.F.W., Bell, R., McCann, J., & Rauch, R. (2006). Aggression after traumatic brain injury: Analysing socially desirable responses and the nature of aggressive traits. Brain Injury, 20, 1163–1173.CrossRefGoogle ScholarPubMed
Eames, P.G. (1990). Organic bases of behaviour disorders after traumatic brain injury. In Wood, R.Ll. (Ed.), Neurobehavioural sequelae of traumatic brain injury. Hove: Psychology Press.Google Scholar
Eames, P.G. (2001). Distinguishing the neuropsychiatric, psychiatric, and psychological consequences of acquired brain injury. In Wood, R.Ll. & McMillan, T. (Eds.), Neurobehavioural disability and social handicap following traumatic brain injury. Hove: Psychology Press.Google Scholar
Feeney, T., & Ylvisaker, M. (2003). Context-sensitive behavioural supports for young children with TBI. Journal of Head Trauma Rehabilitation, 18, 33–51.CrossRefGoogle ScholarPubMed
Feeney, T., & Ylvisaker, M. (2006). Context-sensitive behavioural supports for young children with TBI: a replication study. Brain Injury, 20, 629–645.CrossRefGoogle ScholarPubMed
Ferguson, S.D., & Coccaro, E.F. (2009). History of mild to moderate traumatic brain injury and aggression in physically healthy participants with and without personality disorder. Journal of Personality Disorders, 23, 230–239.CrossRefGoogle ScholarPubMed
Fleminger, S., Greenwood, R.J., & Oliver, D.L. (2006). Pharmacological management for agitation and aggression in people with acquired brain injury. Cochrane Database Systematic Review, Issue 4. Art.No.: CD003299. DOI: 10.1002/14651858.CD003299.pub2.CrossRefGoogle ScholarPubMed
Giles, G.M., & Mohr, J.D. (2007). Overview and inter-rater reliability of an incident-based rating scale for aggressive behaviour following traumatic brain injury: the Overt Aggression Scale-Modified for Neurorehabiltation-Extended (OAS-MNR-E). Brain Injury, 21, 505–511.CrossRefGoogle ScholarPubMed
Giles, G.M., Wagner, J., Fong, L., & Waraich, B.S. (2005). Twenty-month effectiveness of a non aversive, long-term, low-cost programme for persons with persisting neurobehavioural disability. Brain Injury, 19, 753–764.CrossRefGoogle ScholarPubMed
Giles, G.M., Wilson, J., & Dailey, W. (2009). Non-aversive treatment of repetitive absconding behaviour in clients with severe neuropsychiatric disorders. Neuropsychological Rehabilitation, 19, 28–40.CrossRefGoogle ScholarPubMed
Hall, K.M., Karzmark, P., Stevens, M., Englander, J., O'Hare, P., & Wright, J. (1994). Family stressors in traumatic brain injury: a two-year follow-up. Archives of Physical Medicine and Rehabilitation, 75, 876–884.CrossRefGoogle ScholarPubMed
Hawton, K., Salkovskis, P.M., Kirk, J., & Clark, D.M. (Eds.) (1989). Cognitive behaviour therapy for psychiatric problems: A practical guide. Oxford: Oxford University Press.Google Scholar
Hillier, S.L., & Metzer, J. (1997). Awareness and perceptions of recovery post traumatic brain injury. Brain Injury, 7, 525–536.CrossRefGoogle Scholar
Johnston, J.M., Foxx, R.M., Jacobson, J.W., Green, G. & Mulick, J.A. (2006). Positive behavior support and applied behavior analysis. The Behavior Analyst, 29, 51–74.CrossRefGoogle ScholarPubMed
Johnson, R., & Balleny, H. (1996). Behavioural problems after brain injury: Incidence and need for treatment. Clinical Rehabilitation, 10, 173–181.CrossRefGoogle Scholar
Keenan, M. (2004). Autism in Northern Ireland: the tragedy and the shame. The Psychologist, 17, 72–75.Google Scholar
Kelly, G., Brown, S., Todd, J., & Kremer, P. (2008). Challenging behaviour profiles of people with acquired brain injury living in community settings. Brain Injury, 22, 457–470.CrossRefGoogle ScholarPubMed
Kelly, G., Todd, J., Simpson, G., Kremer, P., & Martin, C. (2006). The Overt Behaviour Scale (OBS): A tool for measuring challenging behaviours following ABI in community settings. Brain Injury, 20, 307–319.CrossRefGoogle ScholarPubMed
Kim, E. (2002). Agitation, aggression, and disinhibition syndromes after traumatic brain injury. Neurorehabilitation, 17, 297–310.CrossRefGoogle ScholarPubMed
Knight, C., Alderman, N., Johnson, C., Green, S., Birkett-Swan, L., & Yorston, G. (2008). The St Andrew's Sexual Behaviour assessment (SASBA): development of a standardised recording instrument for the measurement and assessment of challenging sexual behaviour in people with progressive and acquired neurological impairment. Neuropsychological Rehabilitation, 18, 129–159.CrossRefGoogle ScholarPubMed
Kreutzer, J.S., Marwitz, J.H., Seel, R., & Serio, C.D. (1996). Validation of a neurobehavioural functioning inventory for adults with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 77, 116–124.CrossRefGoogle ScholarPubMed
Manchester, D., Hodgkinson, A., Pfaff, A., & Nguyen, F. (1997). A non-aversive approach to reducing hospital absconding in a head-injured adolescent boy. Brain Injury, 11, 271–277.Google Scholar
Manchester, D., & Wood, R.Ll. (2001). Applying cognitive therapy in neuropsychological rehabilitation. In Wood, R.Ll. & McMillan, T.M. (Eds.), Neurobehavioural disability and social handicap following traumatic brain injury. Hove: Psychology Press.Google Scholar
McDonnell, A. (2010). Managing aggressive behaviour in care settings: Understanding and applying low arousal approaches. Chichester, UK: Wiley Blackwell.Google Scholar
McMillan, T.M., & Oddy, M. (2001). Service provision for social disability and handicap after acquired brain injury. In Wood, R.Ll. & McMillan, T.M. (Eds.), Neurobehavioural disability and social handicap following traumatic brain injury. Hove, UK: Psychology Press.Google Scholar
Medd, J., & Tate, R.L. (2000). Evaluation of an anger management therapy programme following acquired brain injury: a preliminary study. Neuropsychological Rehabilitation, 10, 185–201.CrossRefGoogle Scholar
Miller, E., & Cruzat, A. (1981). A note on the effects of irrelevant information on task performance after mild and severe head injury. British Journal of Social and Clinical Psychology, 20, 69–70.CrossRefGoogle ScholarPubMed
Miller, L. (1994). Traumatic brain injury and aggression. Journal of Offender Rehabilitation, 2, 91–103.CrossRefGoogle Scholar
Narevic, E., Giles, G.M., Rajadhyax, R., Managuelod, E., Monis, F., & Diamond, F. (2011). The effects of enhanced program review and staff training on the management of aggression among clients in a long-term neurobehavioral rehabilitation program. Aging and Mental Health, 15, 103–112.CrossRefGoogle Scholar
O'Neill, H. (2006). Managing anger (2nd ed.). London: Whurr.Google Scholar
Port, A., Willmott, C., & Charlton, J. (2002). Self-awareness following traumatic brain injury and implications for rehabilitation. Brain Injury, 16, 277–289.CrossRefGoogle ScholarPubMed
Prigatano, G.P. (1987). Psychiatric aspects of head injury: Problem areas and suggested guidelines for research. BNI Quarterly, 3, 2–9.Google Scholar
Pryor, J. (2004). What environmental factors irritate people with acquired brain injury? Disability and Rehabilitation, 26, 974–980.CrossRefGoogle ScholarPubMed
Psalia, K., & Gracey, F. (2009). The mood management group. In Wilson, B.A., Gracey, F., Evans, J.J. & Bateman, A. (Eds.), Neuropsychological rehabilitation: theory, models, therapy and outcome. Cambridge: Cambridge University Press.Google Scholar
Rahman, B., Oliver, C., & Alderman, N. (2010). Descriptive functional analysis of challenging behaviours shown by adults with acquired brain Injury. Neuropsychological Rehabilitation, 20, 212–238.CrossRefGoogle ScholarPubMed
Rao, V.R., & Lyketsos, M.D. (2000). Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics, 41, 95–103.CrossRefGoogle ScholarPubMed
Rothwell, N.A., LaVigna, G.W., & Willis, T.J. (1999). A non-aversive rehabilitation approach for people with severe behavior problems resulting from brain injury. Brain Injury, 13, 521–533.CrossRefGoogle Scholar
Scott, J. (1997). Advances in cognitive therapy. Current Opinion in Psychiatry, 10, 256–260.CrossRefGoogle Scholar
Slifer, K.J., & Amari, A. (2009). Behavior management for children and adolescents with acquired brain injury. Developmental Disabilities Research Review, 15, 144–151.CrossRefGoogle ScholarPubMed
Slifer, K.J., Tucker, C.L., Gerson, A.C., Sevier, R.C., Kane, A.C., Amari, A., . . . Clawson, B.P. (1997). Antecedent management and compliance training improve adolescents’ participation in early brain injury rehabilitation. Brain Injury, 11, 877–889.Google ScholarPubMed
Starkstein, S.E., & Robinson, R.G. (1991). The role of the human lobes in affective disorder following stroke. In Levin, H.S., Eisenberg, H.M. & Benton, A.L. (Eds.), Frontal lobe function and dysfunction. Oxford: Oxford University Press.Google Scholar
Stewart, I., & Alderman, N. (2010). Active versus passive management of post acquired brain injury challenging behaviour: a case study analysis of multiple operant procedures in the treatment of challenging behaviour maintained by negative reinforcement. Brain Injury, 24, 1616–1627.CrossRefGoogle ScholarPubMed
Stubbs, B., Winstanley, S., Alderman, N., & Birkett-Swan, L. (2009). The risk of assault to physiotherapists: beyond zero tolerance? Physiotherapy, 95, 134–139.CrossRefGoogle ScholarPubMed
Sturmey, P. (Ed.) (2009). Clinical case formulation: varieties of approaches. Chichester: John Wiley & Sons.CrossRefGoogle Scholar
Tateno, A., Jage, R.E., & Robinson, R.G. (2003). Clinical correlates of aggressive behaviour after traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 155–160.CrossRefGoogle ScholarPubMed
Teichner, G., Golden, C., & Giannaris, W. (1999). A multimodal approach to treatment of aggression in a severely brain injured adolescent. Rehabilitation Nursing, 24, 207–211.CrossRefGoogle Scholar
Turner-Stokes, L. (1999). Outcome measures for inpatient neurorehabilitation settings. Neuropsychological Rehabilitation, 9, 385–400.CrossRefGoogle Scholar
Uomoto, J.M., & Brockway, J.A. (1992). Anger management training for brain injured patients and their families. Archives of Physical Medicine and Rehabilitation, 73, 674–679.Google Scholar
Walker, A.J., Nott, M.T., Doyle, M., Onus, M., McCarthy, K., & Baguley, I.J. (2010). Effectiveness of a group anger management programme after severe traumatic brain injury. Brain Injury, 24, 517–524.CrossRefGoogle ScholarPubMed
Watson, C., Rutterford, N., Shortland, D., Williamson, N., & Alderman, N. (2001). Reduction of chronic aggressive behaviour ten years after brain injury. Brain Injury, 15, 1003–1015.CrossRefGoogle Scholar
Whitehouse, A.M. (1994). Applications of cognitive therapy with survivors of head injury. Journal of Cognitive Psychotherapy: An International Quarterly, 8, 141–160.CrossRefGoogle Scholar
Willis, T., & LaVigna, G. (2003). The safe management of physical aggression using multi-element positive practices on community settings. Journal of Head Trauma Rehabilitation, 18, 75–87.CrossRefGoogle ScholarPubMed
Wilson, B. (1989). Injury to the central nervous system. In Pearce, S. & Wardle, J. (Eds.), The practice of behavioural medicine. Oxford: Oxford University Press.Google Scholar
Wilson, B.A. (1991). Behavior therapy in the treatment of neurologically impaired adults. In Martin, P.R. (Ed.), Handbook of behavior therapy and psychological science: an integrative approach. New York: Pergamon Press.Google Scholar
Wood, R.Ll. (1987). Brain injury rehabilitation: A neurobehavioural approach. London: Croom Helm.Google Scholar
Wood, R.Ll. (1990). Conditioning procedures in brain injury rehabilitation. In Wood, R.Ll. (Ed.), Neurobehavioural sequelae of traumatic brain injury. Hove: Psychology Press.Google Scholar
Wood, R.L. (2001). Understanding neurobehavioural disability. In Wood, R.Ll. & McMillan, T. (Eds.), Neurobehavioural disability and social handicap following traumatic brain injury. Hove: Psychology Press.Google Scholar
Wood, R.Ll., & Alderman, N. (2011). Applications of operant learning theory to the management of challenging behaviour after traumatic brain injury. Journal of Head Trauma Rehabilitation, 26, 202–211.CrossRefGoogle Scholar
Woodhead, E.L., & Edelstein, B.A. (2008). Decreasing physical aggression and verbal abuse in a brain injured nursing home resident. Clinical Case Studies, 7, 301–311.CrossRefGoogle Scholar
Ylvisaker, M., Turkstra, L.S., & Coelho, C. (2005). Behavioural and social interventions for individuals with traumatic brain injury: a summary of the research with clinical implications. Seminars in Speech and Language, 26, 256–267.CrossRefGoogle ScholarPubMed
Ylvisaker, M., Turkstra, L., Coehlo, C., Yorkston, K., Kennedy, M., Moore Sohlberg, M., . . . Avery, J. (2007). Behavioural interventions for children and adults with behaviour disorders after TBI: A systematic review of the evidence. Brain Injury, 21, 769–805.CrossRefGoogle ScholarPubMed
Yody, B.B., Schaub, C., Conway, J., Peters, S., Strauss, D., & Helsinger, S. (2000). Applied behavior management and acquired brain injury: approaches and assessment. Journal of Head Trauma Rehabilitation, 15, 1041–1060.CrossRefGoogle ScholarPubMed