The impact of brain injury is life-long and recovery follows the same time course. While it was once believed that the rehabilitation period lasted up to two years maximum, newer research suggests otherwise (Olver, 1996). In this paper, we present both qualitative and quantitative data on severely brain injured residential clients with severe aggression and behavioural challenges initially on admission to the program. After long-term (decades) multimodal management, we show a significant improvement on quality of life, which demonstrate that recovery from brain injury is lifelong. 
Methods 
Using a multidisciplinary approach, our clinical team of a neuropsychiatrist, neuropsychologist, social worker, and behaviour therapist, work closely with the residential manager, residential team leader (senior staff) and front line residential staff to provide consultation and program recommendations at bi-weekly meetings. We collect extensive data on behaviours; antecedent; other psychiatric and medical cormobidity; psychopharmacological management titrated to neuropsychiatric improvement; community involvement; use of resources; and safety of patients, staff and community to name a few to ensure that our treatments remain effective and promote recovery in the long term. A main focus of our approach includes individualized programming using a behaviour support system focused on using an antecedent approach to behaviour management – such as environmental control, incorporating structure and routine (i.e. showers/ ADL’s, etc.) and consistent responses to maladaptive behaviour. This used in combination with carefully monitored psycho-pharmacological intervention promotes and reinforces adaptive/functional replacement behaviours.

Results
Our data demonstrates significant improvement in aggression and other neuropsychiatric parameters of improved functioning in clients with a severe brain injury over a ten-year period. This behavioural stabilization allowed for functional and rehabilitative improvements such as increased ADL independence (presented in one case study) and increased opportunities for engagement (presented in a second case study). 
The case studies presented illustrate that with continued and long-term support, ABI survivors can continue to make functional and rehabilitative gains, long after the initial two year post-brain injury recovery period. Our work also shows that long term behavioural and psychopharmalogical intervention can make a huge impact in stabilizing and a continually improving the quality of life for these clients.
Conclusions
Brain injury is a chronic disability that requires life-long support. Although recovery following the two year period after injury is slower, gains can continue to be made. Our data support the theory that the application of a long-term, dynamic, multidisciplinary support system enables brain injury survivors to continue to make qualitative and functional gains several years post injury.

Rehabilitation for Life: Continuing Recovery of patients with a Severe Brain injury Over and Beyond a Ten Year Period