Ethical issues in using deception to facilitate rehabilitation for a patient with severe traumatic brain injury.

OBJECTIVE: To explore ethical issues in using deception to improve participation in a patient with severe traumatic brain injury who had not responded to traditional behavioral and pharmacologic approaches. DESIGN: Case study. PARTICIPANT: A male in inpatient neurorehabilitation with history of severe traumatic brain injury and significant behavioral disruption that limited his therapy participation. METHODS: Behavior modification program using principles of operant conditioning that required deception. RESULTS: Participation in therapies significantly improved and disruptive behaviors decreased. CONCLUSION: When used cautiously and with careful consideration of the ethical implications, deception may be permissible as part of an intervention strategy with this population but only as a last resort

Non-pharmacological management of psychiatric disturbances after traumatic brain injury

Persons who suffer traumatic brain injury (TBI) often demonstrate a variety of psychiatric and neuropsychiatric disturbances. Some of those disturbances may be managed by non-pharmacological methods. The methods draw heavily on established principles of psychotherapy and behavioral modification. However, the unique problems imposed by neurocognitive deficits must be factored into any form of non-pharmacological intervention with this patient group. A simple model consolidates information about the important ingredients in the non-pharmacological management of psychiatric disturbances in TBI patients