Studies that evaluated a behavioural treatment with measurable outcomes in adults (16 years and above) with acquired brain injury were eligible for inclusion. Case studies without quantitative data were excluded. Also excluded were: studies of interventions that did not concern behavioural or emotional disorders or psychological problems; studies that dealt primarily with mild or mild-to-moderate severity acquired brain injury; studies that focused on specific skills training, occupational therapy, vocational rehabilitation or job coaching; and studies that described pharmacological interventions or alternative medicine approaches. Acquired brain injury was defined as a cerebral damage that occurred after birth and was not related to congenital disorders, developmental disabilities or processes that progressively damage the brain.
Interventions included behavioural analysis, cognitive-behavioural therapy and comprehensive-holistic rehabilitation programs. Most intervention settings included residential rehabilitation services (community based rehabilitation settings were also used). Almost all participants had severe brain injury. Site of lesion was reported in less than half the studies; most of these participants had frontal lobe injuries. Most participants were described as having specified behavioural problems, predominantly externalising symptoms. The primary diagnosis in most studies was traumatic brain injury; in most cases mixed aetiologies were reported (including anoxia, subarachnoid haemorrhage, rupture of a cerebral artery aneurysm, viral encephalitis, brain tumour and acquired hydrocephalus). Chronicity, where reported, varied across studies: most individuals initiated treatment within one to four since injury (range within one month up to 36 years). Treatment duration ranged from two weeks to 10 years. The primary outcome in behavioural analysis studies was decreased intensity and frequency of specific externalising behaviours. Studies that reported cognitive-behavioural therapies or comprehensive-holistic programmes mostly considered behavioural and psychosocial changes as assessed by a variety of productivity level, standardised functional scales and customised rating scales or self-rated questionnaires.
Two reviewers independently selected studies from the retrieved full papers for inclusion in the review; any disagreements were resolved by discussion or arbitration with a third reviewer.