Abstract
Background: Behavioral and cognitive problems are among the most common and troubling consequences of traumatic brain injury. Furthermore, behavioral and cognitive challenges typically interact in complex ways, necessitating an integrated approach to intervention and support.
Objectives: This article reviews literature on behavioral outcome in children and adults with traumatic brain injury, traditional approaches to behavioral intervention and cognitive rehabilitation, and the history, principles, and assessment and treatment procedures associated with context-sensitive, support-oriented approaches to behavioral and cognitive intervention. We propose a clinical framework that integrates cognitive and behavioral intervention themes.
AFTER BRIEFLY summarizing the literature on behavioral and psychosocial outcome after traumatic brain injury (TBI) in children and adults, we describe and offer a rationale for a context-sensitive, support-oriented approach to serving individuals with chronic difficulties in the interacting domains of behavior and cognition. We begin with historical observations about the evolution of support perspectives in both domains. We then describe intervention principles, suggest a common framework for functional assessment, and briefly outline support-oriented intervention procedures in both domains. Our main goal is to show that the same conceptual framework can be used to organize successful interventions from behavioral and cognitive perspectives, thus overcoming the fragmentation still present in many service delivery systems. Our discussion draws on theoretical and experimental literatures from several professional domains to support the judgment that this integrated framework is consistent with available research and with the humanistic, person-centered priorities of effective health care systems. Details of intervention plans consistent with this framework can be found in the remaining articles in this journal issue.