What is the neurobehavioural therapy approach to brain injury rehabilitation?

People often wonder how rehabilitation works, and what it can achieve. A paper recently published on Frontiers Rehabilitation Sciences [1] describes how we do it in The Disabilities Trust.

Rudi Coetzer, Clinical Director, and Sara da Silva Ramos, Senior Research Fellow, explain how our approach maintains the principles originally developed by Rodger Wood [2], who founded our first brain injury rehabilitation centre (Thomas Edward Mitton House in Milton Keynes), but has also recently evolved to adapt to changes in referral patterns, and patient needs within a broader, longer-term clinical pathway and UK health and social care context.

If readers are wondering, we would say that one of the underpinning principles of our approach is that every interaction is rehab (also one of our mantras). In practice this means that new learning is supported 24/7, by rehabilitation support workers and other floor staff who apply the core principles “prescribed” by a transdisciplinary clinical team. For example, these members of staff may deliver key behavioural strategies, such as feedback and reinforcement, and do so in every suitable interaction, every day, which facilitates opportunities for generalization of rehabilitation gains across environments, bringing to life the Hebbian principle that neurons that fire together wire together [3]. In addition, the high frequency achieved through support workers' contacts with persons in services, further facilitates learning and generalization through repetition. These everyday applications of the approach are guided by neuropsychology-led, transdisciplinary formulations and treatment plans.

The paper not only describes the neurobehavioural therapy approach, but it also evidences its effectiveness through a retrospective analysis of outcome data. This reveals statistically and clinically significant improvements for persons in our services, within all three clinical streams - restoration, compensation and support - which are largely defined by the stage of recovery (most “acute” to most chronic) and by the degree to which neurobehavioural symptoms affect engagement with care and treatment.

The article is part of Frontier’s Research Topic Promoting Participation Following Neurotrauma and is available open access on this link.

References

[1] Coetzer, R., & Ramos, S. D. S. A (2022) Neurobehavioral Therapy (NBT) approach to the rehabilitation and support of persons with brain injury: practice-based evidence from a UK charitable rehabilitation provider. Frontiers in Rehabilitation Sciences, 150, https://doi.org/10.3389/fresc.2022.902702

[2] Wood, R. L. & McMillan T. M. (2011) Neurobehavioural Disability and Social Handicap Following Traumatic Brain Injury, Hove: Psychology Press.

[3] Hebb D. (1949) The Organization of Behavior. New York: Wiley.