title: Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations.
abstract: BACKGROUND
  The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives.
  
  
  METHODS
  The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group.
  
  
  RESULTS
  458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury.
  
  
  CONCLUSIONS
  Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations.
authors.affiliation: Service de MPR, CHU Pellegrin, 33076 Bordeaux Cedex, France. Electronic address: lwiart001@cegetel.rss.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Wiart
authors.affiliation: Service de MPR, Hôpital Henri-Gabrielle, 69230 Saint Genis Laval, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Luauté
authors.affiliation: Service de MPR, CHU de Nantes, 44093 Nantes Cedex 1, France.
authors.forename: Angélique
authors.initials: A
authors.lastname: Stefan
authors.affiliation: Service de MPR, Hôpital René-Sabran, 83400 Giens, France.
authors.forename: David
authors.initials: D
authors.lastname: Plantier
authors.affiliation: Service de MPR, Hôpital Dupuytren, 87042 Limoges cedex, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Hamonet
mesh_terms: D001930:Brain Injuries / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D005196:Family Therapy; D006801:Humans; D001523:Mental Disorders / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy*; D009788:Occupational Therapy; D017410:Practice Guidelines as Topic; D011575:Psychoanalytic Therapy; D011613:Psychotherapy / Q000379:methods*
keywords: Behavioral disorders; Cognitive behavioral therapy; Disorders; Family therapy; Guidelines; Holistic therapy; Other therapies; Psychoanalysis; Psychological; Psychotherapy; Traumatic brain injury