Applications of operant learning theory to the management of challenging behavior after traumatic brain injury.

For more than 3 decades, interventions derived from learning theory have been delivered within a neurobehavioral framework to manage challenging behavior after traumatic brain injury with the aim of promoting engagement in the rehabilitation process and ameliorating social handicap. Learning theory provides a conceptual structure that facilitates our ability to understand the relationship between challenging behavior and environmental contingencies, while accommodating the constraints upon learning imposed by impaired cognition. Interventions derived from operant learning theory have most frequently been described in the literature because this method of associational learning provides good evidence for the effectiveness of differential reinforcement methods. This article therefore examines the efficacy of applying operant learning theory to manage challenging behavior after TBI as well as some of the limitations of this approach. Future developments in the application of learning theory are also considered.