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Brown A, Sewell K, Fisher CA. Characterisation of aggression in Huntington's disease: rates, types and antecedents in an inpatient rehabilitation setting. J Clin Nurs 2017; 26:2922-2931. [PMID: 27731917 DOI: 10.1111/jocn.13614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 10/20/2022]
Abstract
AIMS AND OBJECTIVES To systematically review aggression in an inpatient Huntington's cohort examining rates, types and antecedents. BACKGROUND Although the prevalence of aggression in Huntington's disease is high, research into this problematic behaviour has been limited. Few studies have investigated the nature of aggressive behaviour in Huntington's disease or antecedents that contribute to its occurrence. DESIGN A systematic, double-coded, electronic medical file audit. METHODS The electronic hospital medical records of 10 people with Huntington's disease admitted to a brain disorders unit were audited for a 90-day period using the Overt Aggression Scale-Modified for Neurorehabilitation framework, yielding 900 days of clinical data. RESULTS Nine of 10 clients exhibited aggression during the audit period. Both verbal (37·1%) aggression and physical aggression were common (33·8%), along with episodes of mixed verbal and physical aggression (15·2%), while aggression to objects/furniture was less prevalent (5·5%). The most common antecedent was physical guidance with personal care, far exceeding any other documented antecedents, and acting as the most common trigger for four of the nine clients who exhibited aggression. For the remaining five clients, there was intraindividual heterogeneity in susceptibility to specific antecedents. CONCLUSION In Huntington's sufferers at mid- to late stages following disease onset, particular care should be made with personal care assistance due to the propensity for these procedures to elicit an episode of aggression. However, given the degree of intraindividual heterogeneity in susceptibility to specific antecedents observed in the present study, individualised behaviour support plans and sensory modulation interventions may be the most useful in identifying triggers and managing aggressive episodes. RELEVANCE TO CLINICAL PRACTICE Rates of aggression in Huntington's disease inpatients can be high. Knowledge of potential triggers, such as personal care, is important for nursing and care staff, so that attempts can be made to minimise distress for patients and maximise the personal safety of care staff.
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Affiliation(s)
- Anahita Brown
- Brain Disorders Program, Royal Talbot Rehabilitation Centre, Austin Health, Kew, Melbourne, Vic., Australia
| | - Katherine Sewell
- Brain Disorders Program, Royal Talbot Rehabilitation Centre, Austin Health, Kew, Melbourne, Vic., Australia
| | - Caroline A Fisher
- The Melbourne Clinic, Richmond, Melbourne, Vic., Australia.,Psychology Department, Royal Melbourne Hospital, Parkville, Melbourne, Vic., Australia
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Gagnon J, Simpson GK, Kelly G, Godbout D, Ouellette M, Drolet J. A French adaptation of the Overt Behaviour Scale (OBS) measuring challenging behaviours following acquired brain injury: The Échelle des comportements observables (ÉCO). Brain Inj 2016; 30:1019-25. [DOI: 10.3109/02699052.2016.1148197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alderman N, Major G, Brooks J. What can structured professional judgement tools contribute to management of neurobehavioural disability? Predictive validity of the Short-Term Assessment of Risk and Treatability (START) in acquired brain injury. Neuropsychol Rehabil 2016; 28:448-465. [PMID: 26967151 DOI: 10.1080/09602011.2016.1158115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aggression is a frequently cited outcome of acquired brain injury (ABI). Paradoxically, evidence suggests that ABI clinicians underestimate the risk of violence, and aggression in neurobehavioural services appears more frequent than in forensic/secure psychiatric settings. Risk assessment tools are endemic in the latter and highly beneficial in managing harm. However, none has been validated for ABI. This study examines the predictive validity of ABI violence using one established tool, the Short-Term Assessment of Risk and Treatability (START). It is argued that successful management of aggression in neurobehavioural rehabilitation is partly attributable to ongoing programme calibration following regular review of measures conceptualised for ABI. The predictive ability of START and ABI measures was determined through correlational, receiver operating characteristic and hierarchical multiple regression analyses, using 4559 aggression recordings concerning 76 patients over 4 weeks. The START risk of violence was classed "low" for 50% of the sample and "high" for 13.7%. Significant relationships between individual measures and aggression were evident. However, multivariate analysis confirmed that the best fitting model comprised ABI measures of neurobehavioural disability and functional abilities: START data did not increase explained variance. ABI risk prediction may benefit from development of specific tools. However, these should be conceptualised for ABI to incorporate the diverse range of variables underpinning neurobehavioural disability.
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Affiliation(s)
- Nick Alderman
- a Brain Injury Services, Partnerships in Care , Grafton Manor, Grafton Regis, Northants , UK.,b Brain Injury Research Group, College of Human and Health Science, Swansea University , Swansea , UK
| | - Grace Major
- c School of Psychology, University of Birmingham , Birmingham , UK
| | - Jennifer Brooks
- d Brain Injury Services, Partnerships in Care , Elm Park, Ardleigh , UK
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Wiart L, Luauté J, Stefan A, Plantier D, Hamonet J. Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations. Ann Phys Rehabil Med 2016; 59:31-41. [PMID: 26776320 DOI: 10.1016/j.rehab.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives. METHOD The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group. RESULTS 458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury. CONCLUSION Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations.
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Affiliation(s)
- Laurent Wiart
- Service de MPR, CHU Pellegrin, 33076 Bordeaux Cedex, France.
| | - Jacques Luauté
- Service de MPR, Hôpital Henri-Gabrielle, 69230 Saint Genis Laval, France
| | | | - David Plantier
- Service de MPR, Hôpital René-Sabran, 83400 Giens, France
| | - Julia Hamonet
- Service de MPR, Hôpital Dupuytren, 87042 Limoges cedex, France
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Shannon TE, Griffin SL. Managing aggression in global amnesia following herpes simplex virus encephalitis: The case of E.B. Brain Inj 2014; 29:118-24. [DOI: 10.3109/02699052.2014.954623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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6
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Abstract
Emotional and behavioral dyscontrol are relatively common neuropsychiatric sequelae of traumatic brain injury and present substantial challenges to recovery and community participation. Among the most problematic and functionally disruptive of these types of behaviors are pathologic laughing and crying, affective lability, irritability, disinhibition, and aggression. Managing these problems effectively requires an understanding of their phenomenology, epidemiology, and clinical evaluation. This article reviews these issues and provides clinicians with brief and practical suggestions for the management of emotional and behavioral dyscontrol.
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Affiliation(s)
- David B Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA; Neuropsychiatry Service, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Hal S Wortzel
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Neuropsychiatry Service, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA; VISN 19 MIRECC, Denver Veterans Medical Center, Denver, CO, USA
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7
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Rehabilitation Approaches to the Management of Aggressive Behaviour Disorders after Acquired Brain Injury. BRAIN IMPAIR 2013. [DOI: 10.1017/brimp.2013.7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Symptoms of neurobehavioural disability acquired through brain injury, especially aggression, are associated with severe social handicap. Differences in terminology have resulted in varying estimates, but aggressive behaviour disorder appears to be characteristic of survivors at some point in their recovery journey. This paper provides a brief review regarding the prevalence, development and causes of aggression associated with acquired brain injury (ABI), and what can be done to help manage them. The advantages of using standardised measures conceptualised for ABI in the assessment and formulation of aggressive behaviour disorders are especially highlighted. A range of treatment methods and the evidence base relating to these are described. The contribution of pharmacological therapies, cognitive behavioural therapy and behavioural interventions are explored. It is argued that the strongest evidence base is associated with behaviour therapy, especially when carried out in the context of neurobehavioural rehabilitation, and two case studies are described to illustrate the clinical advantages of interventions derived from operant theory. Comparative lack of ABI experts trained in the management of post-acute behaviour disorders remains a limiting factor.
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Dickens G, Alderman N, Bowers L. Potential severity of aggressive behaviour after acquired brain injury: implications for recording. J Psychiatr Ment Health Nurs 2011; 18:586-94. [PMID: 21848592 DOI: 10.1111/j.1365-2850.2011.01707.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aggression is a consequence of acquired brain injury that may necessitate admission to neurobehavioural services. The 'Overt Aggression Scale - Modified for Neurorehabilitation' (OAS-MNR) is a valid, reliable means of capturing this. A criticism of observational rating scales is they do not reflect factors like intent to harm which results in recording anomalies. 'Attacks' has been proposed as a measure which achieves this within psychiatric settings. Principal goals of this study are to determine the usefulness of measuring similar concepts in neurobehavioural services and further validating both scales. A total of 1066 physical assaults were recorded in 6 weeks by 25 patients in an inpatient neurobehavioural programme using the OAS-MNR. Fifty incidents were also rated on Attacks. Convergent validity for using both measures in neurobehavioural services was found. Modifying OAS-MNR severity scores using one of two factors found to underlie Attacks produced an index that successfully discriminated incidents whose risk necessitated more intrusive intervention, which was not evident otherwise. Modifying scores that objectively reflect severity of physical assaults using measures of perceived intent should be a feature of observational recording scales such as the OAS-MNR. Ensuring robust inter-rater reliability will be essential in any development work.
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Affiliation(s)
- G Dickens
- King's College London Institute of Psychiatry, St Andrew's Academic Centre, Northampton, UK
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Applications of Operant Learning Theory to the Management of Challenging Behavior After Traumatic Brain Injury. J Head Trauma Rehabil 2011; 26:202-11. [DOI: 10.1097/htr.0b013e318217b46d] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Stewart I, Alderman N. Active versus passive management of post-acquired brain injury challenging behaviour: A case study analysis of multiple operant procedures in the treatment of challenging behaviour maintained by negative reinforcement. Brain Inj 2010; 24:1616-27. [DOI: 10.3109/02699052.2010.523050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Walker AJ, Nott MT, Doyle M, Onus M, McCarthy K, Baguley IJ. Effectiveness of a group anger management programme after severe traumatic brain injury. Brain Inj 2010; 24:517-24. [DOI: 10.3109/02699051003601721] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Cattelani R, Zettin M, Zoccolotti P. Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review. Neuropsychol Rev 2010; 20:52-85. [DOI: 10.1007/s11065-009-9125-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 12/21/2009] [Indexed: 12/19/2022]
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Kelly G, Brown S, Todd J, Kremer P. Challenging behaviour profiles of people with acquired brain injury living in community settings. Brain Inj 2009; 22:457-70. [DOI: 10.1080/02699050802060647] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ylvisaker M, Turkstra L, Coehlo C, Yorkston K, Kennedy M, Sohlberg MM, Avery J. Behavioural interventions for children and adults with behaviour disorders after TBI: A systematic review of the evidence. Brain Inj 2009; 21:769-805. [PMID: 17676437 DOI: 10.1080/02699050701482470] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To systematically review the evidence for the effectiveness of behavioural interventions for children and adults with behaviour disorders after TBI. DESIGN Using a variety of search procedures, 65 studies were identified. This literature was reviewed using a set of questions about participants, interventions, outcomes and research methods. PARTICIPANTS The 65 studies included 172 experimental participants, including children and adults. INTERVENTIONS A number of specific intervention procedures were used, falling into three general categories: traditional contingency management, positive behaviour interventions and supports and combined. RESULTS All of the studies reported improvements in behavioural functioning. CONCLUSIONS Behavioural intervention, not otherwise specified, can be considered a treatment guideline for children and adults with behaviour disorders after TBI. Both traditional contingency management procedures and positive behaviour support procedures can be said to be evidence-based treatment options. However, a variety of methodological concerns block stronger conclusions.
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Kelly G, Todd J, Simpson G, Kremer P, Martin C. The overt behaviour scale (OBS): A tool for measuring challenging behaviours following ABI in community settings. Brain Inj 2009; 20:307-19. [PMID: 16537272 DOI: 10.1080/02699050500488074] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The Overt Behaviour Scale (OBS) was designed as a comprehensive measure of common challenging behaviours observed after acquired brain injury (ABI) in community settings. The OBS comprises 34 items in nine categories that measure aggression, inappropriate sexual behaviour, perseveration, wandering, inappropriate social behaviour and lack of initiation. The aim of the current study was to determine the reliability, validity and responsiveness of the OBS. METHOD Two adult community-based samples of people with ABI were recruited. Sample 1 (n= 30) were concurrently evaluated on the OBS by two raters and again 1 week later to test stability. Other validating scales were also administered. Sample 2 (n= 28) were clients of the ABI Behaviour Consultancy who were treated for challenging behaviours and were administered the OBS before treatment commenced and then again 4 months later. RESULTS Inter-rater reliability and stability coefficients for the OBS total score was strong (0.97 and 0.77, respectively). Initial evidence of convergent and divergent validity was shown by the differential pattern of correlations with other measures. Moderate-to-strong coefficients (range 0.37-0.66) were observed between the OBS and other measures that had behavioural content (i.e. Mayo-Portland Adaptability Inventory, Current Behaviour Scale, Neurobehavioural Rating Scale-Revised). Divergent validity was shown by the lack of correlation between the OBS and the sub-scales of these tools that do not measure challenging behaviour. Finally, responsiveness was demonstrated with a significant decrease in OBS scores in the expected direction over the 4-month period. This improvement was confirmed by corroborating evidence from key informants. CONCLUSION The OBS shows promise as a reliable, valid and responsive measure that can be used for the systematic assessment of challenging behaviours in community settings.
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Affiliation(s)
- Glenn Kelly
- ABI Behaviour Consultancy, Epworth Hospital, Victoria, Australia.
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16
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Alderman N. Prevalence, characteristics and causes of aggressive behaviour observed within a neurobehavioural rehabilitation service: Predictors and implications for management. Brain Inj 2009; 21:891-911. [PMID: 17729043 DOI: 10.1080/02699050701543560] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE To describe the characteristics and determinants of aggressive behaviour observed within a neurobehavioural unit. RESEARCH DESIGN Statistical analysis of a database of routinely administered clinical measures, including the Overt Aggression Scale-Modified for Neurorehabilitation. METHODS AND PROCEDURES Records of aggressive behaviour shown by 108 patients over 14 days were studied. Patient characteristics were also captured using 23 items from the Rehabilitation Institute of Chicago-Functional Assessment Scale. Four factors were identified: 'communication', 'cognition/function', 'neurobehavioural disability' and 'mood & self-esteem'. Relationships between patient characteristics, external factors and their interactions with aggression were examined. MAIN OUTCOMES AND RESULTS Many (5548) episodes of aggression were recorded. Whilst most comprised verbal aggression, 729 physical assaults were made on others. Aggressive behaviour typically followed staff prompting or no obvious antecedent. Medical intervention was rare, most aggression was managed by staff not reinforcing this behaviour. Over 80% of physical assaults were made by people rated as having severe symptoms of neurobehavioural disability and poor communication. CONCLUSIONS Neurobehavioural units require sufficient staff resources to engage patients in purposeful activities as these were associated with the least severe aggression. Despite increased OAS-MNR usage, a standardized methodology for investigating aggression is required to ensure compatibility between datasets.
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Affiliation(s)
- Nick Alderman
- St Andrew's Healthcare-Kemsley, St Andrew's Hospital, Northampton, UK.
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Stubbs B, Alderman N. Physical interventions to manage patients with brain injury: An audit on its use and staff and patient injuries from the techniques. Brain Inj 2009; 22:691-6. [DOI: 10.1080/02699050802270022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Swan L, Alderman N. Measuring the relationship between overt aggression and expectations: a methodology for determining clinical outcomes. Brain Inj 2009; 18:143-60. [PMID: 14660227 DOI: 10.1080/02699050310001596923] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The presence of aggressive behaviour following traumatic brain injury imposes special challenges within rehabilitation centres. Survivors of traumatic brain injury constitute a heterogeneous population amongst whom problems with increased irritability and aggression are characteristic. There is a clear need to determine what treatment approaches might be helpful in reducing aggressive behaviour. Whilst single-case experimental methodologies including reversal and multiple baseline designs seem ideal for this purpose, the compelling need to minimize risk can compromise their deployment, especially when aggression takes the form of physical assaults on others. When this is the case, there are difficulties in assessing whether a change in aggressive behaviour represents a successful response to treatment or is simply a function of reduced demand in the environment. The contributions made to understanding the relationship between aggression and expectations made on patients participating within rehabilitation will be explored here. A possible means of quantifying demands using the Neurobehavioural Expectations Scale will be described. Three case studies are presented that suggest that a methodology that employs concurrent use of this tool with the Overt Aggression Scale -- Modified for Neurorehabilitation, can enable objective evaluation to be made of the effects of rehabilitation on behaviour, without increasing risk.
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Affiliation(s)
- Louise Swan
- The Kemsley Division, St. Andrew's Hospital, Northampton, UK
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Cooper-Evans S, Alderman N, Knight C, Oddy M. Self-esteem as a predictor of psychological distress after severe acquired brain injury: An exploratory study. Neuropsychol Rehabil 2008; 18:607-26. [DOI: 10.1080/09602010801948516] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Knight C, Alderman N, Johnson C, Green S, Birkett-Swan L, Yorstan G. The St Andrew's Sexual Behaviour Assessment (SASBA): Development of a standardised recording instrument for the measurement and assessment of challenging sexual behaviour in people with progressive and acquired neurological impairment. Neuropsychol Rehabil 2008; 18:129-59. [DOI: 10.1080/09602010701822381] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Manchester D, Wall G, Dawson P, Jackson H. A forensic peer group approach to bullying after traumatic brain injury. Neuropsychol Rehabil 2007; 17:206-29. [PMID: 17454694 DOI: 10.1080/09602010600696472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A forensic peer group programme adapted for bullying behaviour and antisocial attitudes in three young men with traumatic brain injury (TBI) is presented. Three TBI clients who had previously been resistant to an intensive neurobehavioural rehabilitation residential programme were enrolled into the EQUIP programme. EQUIP focused on teaching pro-social skills as they related to aggression, increasing moral development, and altering pro-aggressive attitudes. The group ran four days per week over six weeks, with each session lasting 30 minutes. Post-group assessment indicated that two of the three participants altered their beliefs regarding antisocial behaviour. At three-month follow up, of the two who demonstrated change one had returned to baseline while the other had maintained his progress. Aggression and bullying behaviour reduced in all three clients during the EQUIP programme and these improvements were maintained at three-month follow up. Self-esteem measures did not alter across the assessment period. Antisocial beliefs and their potential for change in clients with severe TBI are discussed.
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Gordon WA, Zafonte R, Cicerone K, Cantor J, Brown M, Lombard L, Goldsmith R, Chandna T. Traumatic brain injury rehabilitation: state of the science. Am J Phys Med Rehabil 2006; 85:343-82. [PMID: 16554685 DOI: 10.1097/01.phm.0000202106.01654.61] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Wayne A Gordon
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, New York 10029-6574, USA
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23
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Baguley IJ, Cooper J, Felmingham K. Aggressive behavior following traumatic brain injury: how common is common? J Head Trauma Rehabil 2006; 21:45-56. [PMID: 16456391 DOI: 10.1097/00001199-200601000-00005] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the prevalence and predictors of aggressive behavior among traumatic brain injury (TBI) survivors at 6, 24, and 60 months postdischarge. DESIGN Mixed cross-sectional and longitudinal data from a 5-year follow-up study of discharged TBI patients analyzed retrospectively. SETTING A specialized Brain Injury Rehabilitation Service of a tertiary referral hospital. PATIENTS Two hundred twenty-eight (228) patients with moderate to severe TBI. MAIN OUTCOME MEASURES The Overt Aggression Scale; injury-related variables (in particular, Glasgow Coma and Outcome scales and posttraumatic amnesia duration); and a battery of postdischarge questionnaires (Beck Depression Inventory, Trauma Complaints List, General Health Questionnaire, etc). RESULTS At any given follow-up period, 25% of the participants were classified as aggressive. Aggression, where present, was consistently associated with depression, concurrent traumatic complaints, younger age at injury, and low satisfaction with life rather than with injury, demographic, or premorbid characteristics. Depression was the factor that was most significantly associated with aggressive behavior at all times postinjury, followed by a younger age at the time of injury. CONCLUSIONS Aggression is a common, fluctuating, and long-term problem following TBI. The underlying association between aggression and psychosocial variables lends support to the provision of ongoing outreach services and psychological and behavioral interventions for all affected TBI survivors.
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Affiliation(s)
- Ian J Baguley
- Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia.
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24
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Abstract
A 3-stage model of intervention is used to contrast the philosophy and treatment practices of 2 behavioral approaches to behavior disorder following traumatic brain injury. The first referred to here as the Operant Neurobehavioral Approach developed from neuropsychology and learning theory. The second referred to as the Relational Neurobehavioral Approach builds on the nonaversive behavioral techniques of the Operant Neurobehavioral Approach. It also incorporates principles of motivational interviewing, places more overt emphasis on the therapeutic relationship, and targets staff attributions for aggression in staff training. The strengths and weaknesses of both approaches are discussed. It is suggested that the Relational Neurobehavioral Approach is more likely to engage and/or reengage clients with traumatic brain injury who are resistant to behavior change. Research implications are discussed including the need to measure the fidelity of all intervention variables.
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25
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Schoof-Tams K. Stellungnahme der Gesellschaft für Neuropsychologie e. V. (GNP) zum Fragenkatalog “Ambulante Neuropsychologie” des gBA (Gemeinsamen Bundesausschuss). ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2006. [DOI: 10.1024/1016-264x.17.1.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Giles GM, Wager J, Fong L, Waraich BS. Twenty-month effectiveness of a non-aversive, long-term, low-cost programme for persons with persisting neurobehavioural disability. Brain Inj 2005; 19:753-64. [PMID: 16175836 DOI: 10.1080/02699050500110108] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PRIMARY OBJECTIVE To examine the effectiveness of a programme developed for persons with persisting neurobehavioural/ neuropsychiatric disorders. RESEARCH DESIGN Descriptive study of a programme that has a philosophy of normalization, respect, non-confrontation, positive engagement, support and functional and behavioural skill development. METHODS AND PROCEDURES Participants were the 40 clients admitted during the initial 20 months of operation. Prior to admission clients had recurrent placement failures secondary to behavioural disregulation and typically were housed at County or State Hospitals. An expanded version of the Overt Aggression Scale Modified for Neurorehabilitation was used to provide detailed descriptions of assaults. MAIN OUTCOMES AND RESULTS Over the 20-month period, 49 incidents of client-to-client aggression occurred representing a rate of 0.11 incidents per client month. Thirty-five of 40 clients remained at the end of 20 months, with only three discharges due to behaviour. CONCLUSIONS A long-term, stable living environment has been provided for individuals who had been intractable management problems elsewhere.
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Affiliation(s)
- G M Giles
- Crestwood Treatment Center, Fremont, CA, USA.
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Abstract
Posttraumatic agitation is a challenging problem for acute and rehabilitation staff, persons with traumatic brain injury, and their families. Specific variables for evaluation and care remain elusive. Clinical trials have not yielded a strong foundation for evidence-based practice in this arena. This review seeks to evaluate the present literature (with a focus on the decade 1995-2005) and employ previous clinical experience to deliver a review of the topic. We will discuss definitions, pathophysiology, evaluation techniques, and treatment regimens. A recommended approach to the evaluation and treatment of the person with posttraumatic agitation will be presented. The authors hope that this review will spur discussion and assist in facilitating clinical care paradigms and research programs.
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Affiliation(s)
- Lisa A Lombard
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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28
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Gauggel S, Sturm W. Leitlinien der Gesellschaft für Neuropsychologie (GNP) für neuropsychologische Diagnostik und Therapie. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2005. [DOI: 10.1024/1016-264x.16.4.175] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fayol P. [Non-pharmacological treatment of neurobehavioural disorders following severe traumatic brain injury. A commented literature review]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2003; 46:97-103. [PMID: 12676415 DOI: 10.1016/s0168-6054(03)00017-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Neurobehavioural disorders are a major public health problem and a daily challenge for neurological rehabilitation. This review presents the state of art in the field of traumatic brain injury regarding non-pharmacological treatments of neurobehavioral disorders. METHODOLOGY Medline data base and main reference books going back for 15 years were searched. RESULTS Prevention is based on information and counselling for a better coherence in the care and a better understanding of behaviour problems. Prevention of complications is based on adaptation of units and management (one-on-one care for example). Non-pharmacological treatment can be classified according to 3 approaches: (1) Behavioural approaches: with well-established procedures for each patient; (2) Holistic approaches: addressing both lesional and psychopathological as well as environmental features; (3) Psychotherapeutic approaches: either integrated to holistic programs, or adapted from classical psychotherapy, or systemic therapy. CONCLUSION Practices trend to a convergence through a comprehensive approach: behaviour analysis and management of its neuropsychological, psychopathological and environmental components. Everybody will be able to pick out elements adaptable for his own practice.
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Affiliation(s)
- P Fayol
- Service de psycho-réhabilitation, centre hospitalier Esquirol, 15, rue du Docteur-Marcland, 87025 Limoges cedex, France.
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[Pharmacological treatment of post-traumatic behavioural disorders]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2003; 46:49-57. [PMID: 12657482 DOI: 10.1016/s0168-6054(02)00353-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Literature review of the data concerning pharmacologic treatment of post-traumatic behavioural disorders. This review is limited to the treatment of agitation, excitation, mood lability, hostility and agressivity as defined by the NRS and excludes pharmacologic treatment of mental slowness, cognitive disorders and depression. METHODS Medline interrogation using keywords Traumatic Brain Injury, Agitation, Agressivity, Behaviour, Pharmacology, Neuroleptics, Benzodiazepines, Carbamazepine, Valproate, Buspirone, SSRI, Propanolol, Methylphenidate and review of recent contents. The data finally includes 29 original studies. RESULTS The overall level of evidence is quite low as the data mainly consist in open studies and case reports. These data and data from reviews or didactic articles suggest the efficiency of a variety of treatments. Mood-stabilizing antiepileptics, and specially carbamazepine constitute together with SSRI antidepressants the first choices. Some data suggest efficiency of buspirone, methylphenidate and atypic neuroleptics. Lithium requires close monitoring but is probably efficient. It is difficult to conclude concerning propanolol. CONCLUSION The available data is in favour of the use of CBZ and SSRI antidepressants. Further studies are required. It is necessary to establish clear evidence of the efficiency of CBZ and assess the effects of methylphenidate, which is almost not prescribed in France.
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Alderman N. Contemporary approaches to the management of irritability and aggression following traumatic brain injury. Neuropsychol Rehabil 2003; 13:211-40. [DOI: 10.1080/09602010244000327] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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