Bobbi Hoadley

The ABC’s of ABA after ABI – I couldn't resist the alliteration

Acquired Brain Injury (ABI) is a term that describes an insult to the brain whether it is from concussion, stroke, traumatic events or disease. Rehabilitation after any Acquired Brain Injury is a process of behavioural change. Survivors must successfully integrate new activities, habits, routines, expectations and attitudes that may be very different from their pre-ABI behaviours.


Applied Behaviour Analysis (ABA) has a unique opportunity to support survivors whose behaviours do not adapt to the new circumstances after an acquired brain injury.  We analyse the function of pre-injury behaviours and how they combined with new brain functions to elicited the post injury adaptations.  The new perspective leads to solutions for the post-injury functioning that has not adapted effectively to cope with new circumstances.

Positive Behaviour Supports draw on ABA technology, and when integrated into rehabilitation plans, improve rehabilitative success and greatly increase the likelihood of lasting behaviour change for recovery. Sohlberg and Mateer, in their landmark book, Cognitive Rehabilitation: an Integrative Neuropsychological Approach, recommend PBS strategies as best practice. Successful rehabilitation professionals including Occupational (OTs) Physical (PTs) and Physiatrists now routinely do their work with positive behaviour support techniques.

When the results of an accident or injury are neurologically based, seemingly new challenging behaviours can present obstacles to the rehabilitation process. The severity of physical impairment, memory loss, and age are typically the predictors of the capacity for return to work. Nevertheless, studies cite psychological problems and challenging behaviour as predictors of poor outcomes in rehabilitation, and whether, how, and when these factors emerge is unpredictable. When any type of rehabilitation with potential for positive outcomes fails to progress, behaviour challenges are frequently the factor cited as the barrier.

Collecting empirical evidence of progress and reporting data is increasingly recognized as necessary for the effective allocation of resources in rehabilitation. With Applied Behaviour Analysis data collection is an important aspect of treatment to ensure that progress is ongoing, or that intervention strategies are continuously measured and adjusted to ensure continuous positive growth. The ongoing collection of objective, observable and measurable information provides feedback to the survivor and their rehab team, as well as evidence of successful outcomes.

Complex behaviour or behaviour that is resistant to supportive change processes in rehabilitation for Acquired Brain Injuries, gain a huge cost benefit from the services of a Board Certified Behaviour Analyst (BCBA) to functionally analyze the contexts of the behaviour and provide a framework for professional supports for behaviour change.