Semin Speech Lang 2005; 26(4): 256-267
DOI: 10.1055/s-2005-922104
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Behavioral and Social Interventions for Individuals with Traumatic Brain Injury: A Summary of the Research with Clinical Implications

Mark Ylvisaker1 , Lyn S. Turkstra2 , Carl Coelho3
  • 1College of Saint Rose, Albany, New York
  • 2Department of Communicative Disorders, University of Wisconsin-Madison, Madison, Wisconsin
  • 3Communication Sciences, University of Connecticut, Storrs, Connecticut
Further Information

Publication History

Publication Date:
09 November 2005 (online)


Specialists in communication disorders who work with individuals who have traumatic brain injury (TBI) often focus their rehabilitative efforts on the cognitive, social, and behavioral dimensions of disability. These domains of functioning are included in the scope of practice of the American Speech-Language and Hearing Association because of their close associations with communication effectiveness. This article summarizes relevant research findings and clinical perspectives in the areas of intervention for disorders of behavioral self-regulation and social-interactive competence after TBI. This clinical summary is associated with a systematic evidence review sponsored by the TBI Practice Guidelines Group of the Academy of Neurologic Communication Disorders and Sciences (ANCDS).


  • 1 Ylvisaker M, Jacobs H E, Feeney T. Positive supports for people who experience behavioral and cognitive disability after brain injury: a review.  J Head Trauma Rehabil. 2003;  18 7-32
  • 2 Max J E, Robin D A, Lindgren S D et al.. Traumatic brain injury in children and adolescents: psychiatric disorders at two years.  J Am Acad Child Adolesc Psychiatry. 1997;  36 1278-1285
  • 3 Costeff H, Grosswasser Z, Landman Y, Brenner T. Survivors of severe traumatic brain injury in childhood: I, late residual disability.  Scand J Rehabil Med. 1985;  12(suppl) 10-15
  • 4 Tate R L. “It is not only the kind of injury that matters, but the kind of head”: the contribution of premorbid psychosocial factors to rehabilitation outcomes after severe traumatic brain injury.  Neuropsychol Rehabil. 1998;  8 1-18
  • 5 Tate R L, Broe G A. Psychosocial adjustment after traumatic brain injury: what are the important variables?.  Psychol Med. 1999;  29 713-725
  • 6 Schwartz L, Taylor H G, Drotar D, Yeates K O, Wade S L, Stancin T. Long-term behavior problems following pediatric traumatic brain injury: prevalence, predictors, and correlates.  J Pediatr Psychol. 2003;  28 251-263
  • 7 Brooks D N, Campsie L, Symington C, Beattie A, Bryden J, McKinley W. The effects of severe head injury upon patient and relative within seven years of injury.  J Head Trauma Rehabil. 1987;  2 1-13
  • 8 Lezak M. Psychological implications of traumatic brain damage for the patient's family.  Rehabil Psychol. 1986;  31 241-250
  • 9 Morton M V, Wehman P. Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations.  Brain Inj. 1995;  9 81-92
  • 10 Perlesz A, Kinsella G, Crowe S. Psychological distress and family satisfaction following traumatic brain injury: injured individuals and their primary, secondary, and tertiary carers.  J Head Trauma Rehabil. 2000;  15 909-929
  • 11 Taylor H G, Yeates K O, Wade S L, Drotar D, Stancin T, Minich N. A prospective study of short- and long-term outcomes after traumatic brain injury in children: behavior and achievement.  Neuropsychology. 2002;  16 15-27
  • 12 Kendall E, Terry D J. Psychosocial adjustment following closed head injury: a model for understanding individual differences and predicting outcome.  Neuropsychol Rehabil. 1996;  6 101-132
  • 13 Lishman W A. The psychiatric sequelae of head injury: a review.  Psychol Med. 1973;  3 304-318
  • 14 Stuss D T, Benson D F. The Frontal Lobes. New York; Raven Press 1986
  • 15 Scheibel R S, Levin H S. Frontal lobe dysfunction following closed head injury in children and adults. In: Krasnegor NA, Lyon GR, Goldman-Rakic PS Development of the Prefrontal Cortex: Evolution, Neurobiology, and Behavior. Baltimore, MD; Paul Brookes Publishing 1997: 241-263
  • 16 Max J E, Roberts M A, Koele S L et al.. Cognitive outcome in children and adolescents following severe traumatic brain injury: influence of psychosocial, psychiatric, and injury-related variables.  J Int Neuropsychol Soc. 1999;  5 58-68
  • 17 Levin H S, Goldstein F C, Williams D H, Eisenberg H M. The contribution of frontal lobe lesions to the neurobehavioral outcome of closed head injury. In: Levin HS, Eisenberg HM, Benton AI Frontal Lobe Function and Dysfunction. New York; Oxford University Press 1991: 318-338
  • 18 Stuss D T, Gallup G G, Alexander M P. The frontal lobes are necessary for ‘theory of mind’.  Brain. 2001;  124 279-286
  • 19 Turkstra L S, McDonald S, DePompei R. Social information processing in adolescents: data from normally developing adolescents and preliminary data from their peers with traumatic brain injury.  J Head Trauma Rehabil. 2001;  16 469-483
  • 20 Turkstra L. Should my shirt be tucked in or left out? The communication context of adolescence.  Aphasiology. 2000;  14 349-364
  • 21 McDonald S. Are you crying or laughing? Emotion recognition deficits after severe traumatic brain injury.  Brain Impairment. 2005;  6 56-67
  • 22 Shammi P, Stuss D T. Humour appreciation: a role of the right frontal lobe.  Brain. 1999;  122 657-666
  • 23 Stuss D T, Alexander M P. Affectively burnt in: a proposed role of the right frontal lobe. In: Tulving E Memory, Consciousness and the Brain. Philadelphia, PA; Psychology 1999: 215-227
  • 24 Feeney T J, Ylvisaker M. Context-sensitive behavioral supports for young children with TBI: short-term effects and long-term outcome.  J Head Trauma Rehabil. 2003;  18 33-51
  • 25 Alderman N. Contemporary approaches to the management of irritability and aggression following traumatic brain injury.  Neuropsychol Rehabil. 2003;  13 211-240
  • 26 Wood R L, Eames P. Application of behavior modification in the rehabilitation of traumatically brain-injured patients. In: Davey G Applications of Conditioning Theory. London; Methuen 1981: 81-101
  • 27 Feeney T, Ylvisaker M. Choice and routine: antecedent behavioral interventions for adolescents with severe traumatic brain injury.  J Head Trauma Rehabil. 1995;  10 67-82
  • 28 Feeney T J, Ylvisaker M. A positive, communication-based approach to challenging behavior after ABI. In: Glang A, Singer GHS, Todis B Students with Acquired Brain Injury: The School's Response. Baltimore, MD; Paul H Brookes 1997: 229-254
  • 29 Ylvisaker M, Feeney T J. Collaborative Brain Injury Intervention: Positive Everyday Routines. San Diego, CA; Singular Publishing 1998
  • 30 Stage S A, Quiroz D R. A meta-analysis of interventions to decrease disruptive classroom behavior in public education settings.  School Psych Rev. 1997;  26 333-368
  • 31 Aeschleman S R, Imes C. Stress inoculation training for impulsive behaviors in adults with traumatic brain injury.  J Rational-Emotive Cog Behav Ther. 1999;  17 51-65
  • 32 Wade S L, Michaud L, Maines T. Putting the pieces together: preliminary efficacy of a family problem-solving intervention for children with traumatic brain injury.  J Head Trauma Rehabil. 2005;  , (in press)
  • 33 Medd J, Tate R L. Evaluation of an anger management therapy program following acquired brain injury: a preliminary study.  Neuropsychol Rehabil. 2000;  10 185-201
  • 34 Rolls E T. The orbitofrontal cortex and reward.  Cereb Cortex. 2000;  10 284-294
  • 35 Schlund M W. Effects of acquired brain injury on adaptive choice and the role of reduced sensitivity to contingencies.  Brain Inj. 2002;  16 527-535
  • 36 Damasio A R. Descartes' Error: Emotion, Reason, and the Human Brain. New York; Avon Books 1994
  • 37 Anderson S W, Bechara A, Damasio H, Tranel D, Damasio A R. Impairment of social and moral behavior related to early damage in human prefrontal cortex.  Nat Neurosci. 1999;  2 1032-1037
  • 38 Damasio A R, Tranel D, Damasio H. Individuals with sociopathic behavior caused by frontal damage fail to response autonomically to social stimuli.  Behav Brain Res. 1990;  41 81-94
  • 39 Tranel D, Bechara A, Denburg N L. Asymmetric functional roles of right and left ventromedial prefrontal cortices in social conduct, decision-making, and emotional processing.  Cortex. 2002;  38 589-612
  • 40 Rubin K H, Bukowski W, Parker J. Peer interactions, relationships, and groups. In: Eisenberg N Handbook of Child Psychology: Social, Emotional, and Personality Development. New York; Wiley 1998: 619-700
  • 41 Hoofien D, Gilboa A, Vakil E, Donovick P J. Traumatic brain injury (TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning.  Brain Inj. 2001;  15 189-209
  • 42 Kersel D A, Marsh N V, Havill J H, Sleigh J W. Psychosocial functioning during the year following severe traumatic brain injury.  Brain Inj. 2001;  15 683-696
  • 43 Harrick L, Krefting L, Johnston J, Carlson P, Minnes P. Stability of functional outcomes following transitional living programme participation: 3-year follow-up.  Brain Inj. 1994;  8 439-447
  • 44 Turkstra L S, Dixon T M, Baker K K. Theory of mind and social beliefs in adolescents with traumatic brain injury.  Neurorehabilitation. 2004;  19 245-256
  • 45 Gresham F M, Sugai G, Horner R H. Interpreting outcomes of social skills training for students with high-incidence disabilities.  Exceptional Children. 2001;  67 331-344
  • 46 Barkley R A. Adolescents with attention-deficit/hyperactivity disorder: an overview of empirically based treatments.  J Psychiatr Pract. 2004;  10 39-56
  • 47 Struchen M. Social communication interventions for persons with traumatic brain injury. In: High WM, Sander AM, Struchen MA, Hart KA Rehabilitation Interventions following Traumatic Brain Injury: State of the Science. New York; Oxford University Press 2005: 88-117
  • 48 Helffenstein D, Wechsler R. The use of interpersonal process recall (IPR) in the remediation of interpersonal and communication skill deficits in the newly brain injured.  Clin Neuropsychol. 1982;  4 139-143
  • 49 Cicerone K D, Dahlberg C, Kalmar K et al.. Evidence-based cognitive rehabilitation: recommendations for clinical practice.  Arch Phys Med Rehabil. 2000;  81 1596-1615
  • 50 World Health Organization .International Classification of Functioning, Disability and Health. Report. Geneva: Switzerland; World Health Organization 2001
  • 51 Girolametto L, Sparks B, Weitzman E, Pearce P S. The Effects of Language Intervention on the Play and Behaviour Competencies of Late Talkers. Toronto, Canada; University of Toronto 2003
  • 52 Kagan A, Black S, Duchan J, Mackie N, Square P. Training volunteers as conversation partners using “Supported Conversation for Adults with Aphasia” (SCA): a controlled trial.  J Speech Lang Hear Res. 2001;  44 624-638
  • 53 Ripich D, Ziol E, Fritsch T, Durand E. Training Alzheimer's disease caregivers for successful communication.  Clin Gerontol. 1999;  21 37-53
  • 54 Togher L, McDonald S, Code C, Grant S. Training communication partners of people with traumatic brain injury: a randomised controlled trial.  Aphasiology. 2004;  18 313-335
  • 55 Ylvisaker M, Feeney T. Construction of identity after traumatic brain injury.  Brain Impairment. 2000;  1 12-28

Mark YlvisakerPh.D. 

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