Neurobehavioural rehabilitation of dysexecutive syndrome following traumatic brain injury - a narrative review of management

Background: Traumatic brain injury (TBI) leads to >200,000 hospital admissions in the UK annually. Frontal lobes are frequently affected, leading to a sequela of symptoms affecting behaviour, emotions, and cognition; a cluster of symptoms referred to as dysexecutive syndrome (also known as frontal lobe syndrome). People who survive this, experience long-term sequelae and require long-term support through neurological rehabilitation. The UK has robust guidelines on the medical/physical aspects of rehabilitation following brain injury. However, these guidelines mention little information on the management of neurobehavioural problems following TBI. The aim of this review is to determine what the evidence-based neurobehavioural management of patients with dysexecutive syndrome following TBI is in the UK. Methods: A systematic review of articles using MEDLINE, EMBASE (1974 – present) and Web of Science was conducted. Search terms included frontal lobe syndrome, dysexecutive syndrome, traumatic brain injury, neurorehabilitation, neurological rehabilitation, neurological management, behaviour therapy and behavioural management. Additional references were sourced from the search results and author NH, a medical director within a hospital catering to people with brain injury. Results: 168 results were obtained. 21 articles remained following exclusions: 19 original articles and 2 reviews. Interventions mentioned included: behavioural psychotherapy, memory training, feedback, awareness interventions, goal management training, social skills training, work placements, problem solving training, metacognitive skills, token economy and response cost. Interventions were utilised using a person-centred approach, however, generally there was a lack of consensus as the most effective one. Only 2 studies considered the long-term outcomes of rehabilitation. Discussion: Successful rehabilitation of dysexecutive syndrome post-TBI involves using a person-centred approach, to determine which intervention will target the problem of concern to the patient. Few papers address behavioural rehabilitation of dysexecutive syndrome post-TBI. Further research is required to determine the most effective and beneficial interventions for patients in both the short- and long-term.