Harvey E. Jacobs, PhD, CBIST

Session Summary:

Behavior disorders are often regarded among the most consequential sequela following traumatic brain injury (TBI) onset. From the early years of TBI rehabilitation, the professional literature has reported on a broad range of issues that can also affect family members and other caregivers. Socially dysfunctional behavior is a frequent cause of early treatment termination and inaccessibility to productive daily activity patterns. Common treatment modalities can also produce iatrogenic effects when treatment focuses on suppression of symptoms rather than taking a more integrative approach.

“Behavior” is not solely the providence of dysfunction; behavior is about competencies, capacities and ultimately about a person’s overall performance. It involves everything that a person does and how they react to daily circumstances. It is the window through which we view changes in an individual following presumed neurological impairment -- we don’t directly see a frontal lobe lesion, but may directly experience associated changes regarding performance.

People also respond differently according to the situation they face, the people around them, novelty of events, levels of pain or fatigue and other salient factors; i.e., the context in which the behavior occurs. Understanding changes in internal and external loci of behavioral control can also clarify required future services and supports to optimize life quality and ensure an integrative focus.

Focusing on performance helps to clarify how a person may be able to return to aspects of premorbid capacities and life, where accommodations are needed to pursue premorbid responsibilities or where new pathways are required. These not only include traditional medical and therapeutic approaches, but contextual supports that build on remaining strengths and capacities. The presentation will discuss how these factors integrate in clinical management and in forensic situations.