title: Treatment challenges with profound behaviour disturbance after traumatic brain injury: a case report.
abstract: BACKGROUND
  Severe behavioural disturbances exhibited during the earliest stages of recovery from severe traumatic brain injury often limit the ability to provide standard care. Studies that focus on treatment options for inpatients with such behaviours are scarce. There is limited guidance on how to approach therapy that will maximize the patient's tolerance and participation and how to measure meaningful progress.
  
  
  METHODS
  This case study describes how the use of an innovative treatment approach to improve attention was beneficial in rehabilitation of a patient with severe traumatic brain injury whose profound behaviour disturbances substantially precluded participation in traditional therapies. The study shows how rehabilitation utilizing an interactive virtual reality-robotics environment that minimized distractions was associated with improved engagement in therapy, decreased disruptive behaviour during treatment and more sensitive measurement of progress.
  
  
  CONCLUSIONS
  These results may be instructive in how technology can be used to modify therapy sessions to make them accessible to patients with profound behaviour disturbance and how meaningful progress can be measured even in the absence of gains in traditional metrics.
authors.affiliation: Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL, 60611, USA. sasaf@vms.huji.ac.il
authors.forename: Assaf Y
authors.initials: AY
authors.lastname: Dvorkin
authors.forename: Sonia
authors.initials: S
authors.lastname: Pacini
authors.forename: Nancy
authors.initials: N
authors.lastname: Hsu
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D001521:Behavior Therapy; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D012371:Robotics; D016896:Treatment Outcome; D014584:User-Computer Interface; D063367:Virtual Reality Exposure Therapy