Treating Behavioral Dyscontrol Following Neurologic Injury Produces Improved Outcomes: NeuroRestorative’s Neurobehavioral Programming
Following an injury to some areas of the brain, an individual may experience neurobehavioral dyscontrol, causing disruption and disability within their behavior or a change in their personality. An estimated 11-34% of patients remain with persistent agitated behaviors after discharge from inpatient rehabilitation programs (1,2,3). These changes in behavior are a significant source of family stress and care challenges with a negative impact on societal participation (4).
NeuroRestorative’s neurobehavioral treatment programs specialize in treating high-frequency, high-magnitude behaviors following neurologic injuries that present barriers to positive outcomes. Our research has shown that irritability and agitation have a significant negative (p<0.01) impact on recovery by reducing the essential skills for community living. When people have moderate to severe deficits with control of irritability/agitation, it strongly impacts their ability to initiate tasks (p<0.01), to manage self-care (bathing, grooming, dressing, hygiene; p<0.01), to maintain residential chores (managing one’s living environment; p<0.01), and to participate in meaningful activities in their communities (p<0.01).
NeuroRestorative’s neurobehavioral programs help people to achieve a significant reduction in irritability and agitation through the development of prosocial behavior skills, personalized positive reinforcement for the use of appropriate behavior, and repeated learning trials to shape behavior needed for successful community living.
Figure 1
Both the neurobehavioral and the neurorehabilitation program data demonstrate that individuals served show a moderate to severe level of impairment with behavior regulation. For those in the neurobehavioral programs, the presenting negative behaviors tended to be highly intense, sporadic, and persistent compared to those in the neurorehabilitation program. Data from the neurobehavioral programs indicated that 57% of the individuals who were admitted with severe behavioral dyscontrol were able to improve to a moderate or even mild level of impairment at the time of discharge. This is an observable finding that improves the chances of living in the community. In these programs, behavior modification techniques are taught and practiced repeatedly in the community until successful integration is observed. Persons who enter our programs sooner after injury tend to achieve a greater reduction in disruptive behaviors within a shorter period of time.
Chronicity:
• The neurobehavioral group average was 14 years from the time of injury until admission to NeuroRestorative.
• The neurorehabilitation group average was 2 years from the time of injury until admission to NeuroRestorative.
References:
1.Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI. Disability in young people and adults one year after head injury:
prospective cohort study. BMJ. 2000; 17; 320: 1631-5. doi: 10.1136/bmj.320.7250.1631. PMID: 10856063; PMCID: PMC27407.
2. Johnston M. Outcomes of community re-entry programs for brain injury survivors Part 2 Further investigations. Brain Injury. 1991: 5(2):155-168.
3.Murray C.J. Lopez A.D. Alternative projections of mortality and disability by cause 1990–2020: Global burden of disease study. Lancet. 1997; 349:1498–1504.
4. Winstanley J, Simpson G, Tate R, Myles B. Early indicators and contributors to psychological distress in relatives during rehabilitation following severe traumatic brain injury: Findings from the Brain Injury Outcomes Study. Journal of Head Trauma Rehabilitation. 2006; 21(6): 453-466