Outcome of rehabilitation for neurobehavioural disorders

The evidence base on neurobehavioural disorders and their rehabilitation has been growing for four decades. Over that time understanding of the need for effective interventions for a range of handicaps in personal, interpersonal and employment spheres has developed. There is a continuing need to demonstrate whether interventions, are effective and cost-sensitive. Moreover, in pursuing effectiveness, clinicians need to be able to predict which individuals are likely to benefit from a programme and here, clinical experience needs to be informed by research evidence.

To review the outcome of rehabilitation for neurobehavioural disorders.

This review initially considers the background to neurobehavioural rehabilitation and discusses methodological issues. It reviews the evidence for neurobehavioural interventions for severe head injury with emphasis on holistic models of care, behavioural treatments, interventions in non-specialist settings and for emotion perception and self-awareness.

In general, there is a need for further high quality studies with longer follow-ups and evidence for generalisation in the community. However, there is a growing consensus that intensive holistic rehabilitation programmes can improve community reintegration and self-efficacy. For behaviour disturbance the evidence base largely comprises studies with weaker (single group or single case) designs. Overall studies here provide limited evidence in support of behavioural approaches for externalised behaviour such as aggression. Further RCT or group comparison studies are needed. In terms of negative behaviours such as apathy, there are few studies on head injury and conclusions cannot be made with confidence. Self awareness is a key issue associated with good outcome in general and research to date supports use of interventions that focus in on-task behaviour and education. The correct perception of emotions in others is a precursor to successful social interaction, and here there is very little evidence although early studies are encouraging.

There is mounting evidence to support the effectiveness of non-pharmacological interventions for neurobehavioural disorders. Successful outcomes are often associated with intensive and prolonged interventions involving multidisciplinary working.