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Outcome of rehabilitation for neurobehavioural disorders

MCMILLAN TM
NEUROREHABILITATION , 2013, vol. 32, n° 4, p. 791-801
Doc n°: 167131
Localisation : Centre de Réadaptation de Lay St Christophe

D.O.I. : http://dx.doi.org/DOI:10.3233/NRE-130903
Descripteurs : AL - NEUROREEDUCATION

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. OBJECTIVE: To review the outcome of rehabilitation
for neurobehavioural disorders. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Langue : ANGLAIS

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