A non-aversive rehabilitation approach for people with severe behavioural problems resulting from brain injury

An approach is presented which uses exclusively non-aversive methods in the behavioural rehabilitation of people with severe behaviour problems resulting from acquired brain injury. The approach has five components: (1) behavioural assessment: analysing the way all aspects of a person's functioning may affect their behaviour, (2) positive programming: teaching the skills necessary to allow the person to achieve their desired ends without resorting to inappropriate behaviour, (3) ecological change: altering the environment to achieve a better match with the individual's cognitive deficits, (4) focused treatment: using behavioural contingencies to achieve a rapid reduction in target behaviour, and (5) reactive strategies: specifying action to be taken to gain short-term control over episodes of challenging behaviour. The current literature on behavioural rehabilitation is reviewed in the context of this approach. Two case studies are presented illustrating the use of the approach in practice. The strengths and potential pitfalls of the approach are discussed, along with issues which need to be considered for effective implementation.