Putting behaviour first: How positive behaviour support is transforming brain injury rehabilitation
An Interview with Anna Long, PBS lead, acuity care
People living with an acquired brain injury (ABI) often face challenges that extend far beyond physical recovery.
Behavioural and emotional challenges – frequently misunderstood – can have a profound impact on rehabilitation, relationships, and quality of life.
Anna Long, Positive Behaviour Support (PBS) Lead, shares her insights into how PBS is reshaping neurorehabilitation by placing understanding, compassion, and person-centred care at its core.
Understanding Behaviour After Brain Injury
Behaviour following ABI is rarely straightforward.
Changes in cognition, emotional regulation, and self-awareness can lead to difficulties such as impulsivity, disinhibition, and aggression.
Individuals may act or speak without considering consequences, struggle to regulate emotions, or find it difficult to engage in rehabilitation due to reduced insight or emotional impact after their injury.
“These behaviours are often forms of communication”, Anna, explains.
“They reflect unmet needs, frustration, or difficulty processing the world in the same way as before”.
Positive Behaviour Support addresses these challenges by identifying the underlying triggers and functions of behaviour.
It focuses on reducing environmental stressors, teaching coping and communication skills, and ensuring that support systems respond consistently.
At its heart, PBS is about improving quality of life – helping individuals find safer, more effective ways to express themselves.
Keeping Support Person-Centred
Balancing clinical safety with person-centred care is a key priority in PBS.
Anna emphasises the importance of developing a comprehensive understanding of each individual – not their neurological needs, but also their history, values, strengths, and goals.
“Even when someone has limited capacity to engage, their voice should still guide the process”. she says.
Families, advocates, and support networks play a crucial role in ensuring that behavioural support plans reflect the person’s identity and aspirations.
These plans are not static.
They evolve alongside the individual, adapting to progress, setbacks, and changing needs.
Proactive, least restrictive approaches are prioritised, with multidisciplinary teams working together to manage risk while preserving autonomy and dignity.
Real Impact: Gaining Independence
Anna recalls working with an individual whose life had become highly restricted due to impulsive and socially inappropriate language.
Through PBS, the team identified triggers and introduced structured, proactive strategies, including therapy focused on appropriate communication and gradual exposure to social situations.
Support staff were training to respond consistently, and interventions were regularly reviewed and adapted.
Over time the individual regained confidence and independence, successfully navigating social environments and re-engaging in activities they had previously enjoyed.
“The change wasn’t just behavioural” Anna reflects.
“It had a huge impact on emotional wellbeing and overall quality of life”.
The Power of Collaboration
Consistency is essential in behavioural support, and this relies on strong collaboration.
Anna highlights the importance of building open, respectful relationships with families, support staff, and multidisciplinary teams.
By involving stakeholders in developing support plans, providing education, and modelling effective strategies, PBS creates a shared understanding of how best to respond.
Regular review and open communication ensure that approaches remain effective and responsive.
“Without consistency, even the best strategies can fail”, Anna notes.
“Collaboration is what makes PBS sustainable”.
Challenging Misconceptions
Misunderstandings about behaviour after brain injury remain common.
One of the most persistent is the belief that individuals are fully in control of their actions.
“It’s easy to assume someone is being difficult on purpose.”. Anna says.
“But that overlooks the impact of cognitive impairment, trauma, and reduced insight”.
Similarly, lack of engagement is often misinterpreted as laziness, rather than a reflection of fatigue, emotional overwhelm, or neurological limitations.
PBS encourages a more nuanced perspective – one that considers fluctuating capacity and adapts support accordingly.
Another is conception is underestimating a person’s potential.
Recovery after brain injury is rarely linear, and progress can continue long after expectations have plateaued.
Navigating Complex Challenges
For PBS practitioners, working in neurorehabilitation presents unique challenges.
Behaviour is influenced not only by environmental factors but also by neurological impairments such as memory difficulties, poor impulse control, and communication barriers.
There is also the ongoing challenge of balancing risk management with quality of life.
Restrictive measures may reduce immediate risk but can also limit independence and increase frustration.
Additionally, differences in training and confidence among staff can lead to inconsistency, particularly in high-pressure situations.
Emotional adjustment following ABI – often involving grief, loss, and identity changes – adding another layer of complexity.
The Future of PBS in Neurorehabilitation
Looking ahead, Anna sees a growing role for PBS across the entire rehabilitation pathway.
Increasing recognition of the importance of emotional and behavioural factors is driving earlier intervention, including in acute settings.
“Introducing PBS principles earlier allows for more preventative approaches.” she explains.
“We can focus on building skills, adapting environments, and supporting long-term outcomes from the start.”
A continued commitment to person-centred care will ensure that individuals with ABI are not only supported to recover – but to rebuild meaningful, fulfilling lives.
