ABSTRACT
Non-cooperation with treatment can be an “active” process involving aggression or overt refusal. Where aggression is the primary response, this was considered in more detail in Chapter 6. More commonly however, noncooperation takes a “passive” form of failure to attend sessions, or not participating fully in sessions. There are many reasons why a person with a brain injury may lack motivation or not comply with a treatment programme. First, their cognitive problems may be such that they cannot remember what is expected of them, or they may be unable to organise themselves to respond to a specific request (Zencius, Wesolowski, Burke, & McQuaide, 1989). Second, the person with the brain injury may struggle to initiate activities successfully. Third, they may lack insight into their problems, which is one of the greatest challenges to success in rehabilitation. Fourth, emotional responses such as low mood and anxiety, or learned responses such as learned helplessness or avoidance, may prevent an individual engaging in treatment (Feinstein, 1999). Fifth, the individual’s level of fatigue may reduce their ability to participate fully, and activities and therapy programmes must be structured to give periods of rest as required. Finally there is a general reduction in arousal levels that some patients experience which significantly affects their ability to participate in activities (Andersson, Gundersen, & Finset, 1999) and which may be amenable to pharmacological interventions. A good behavioural analysis is crucial to assist in determining which are the important factors in each case.
