The Overt Behaviour Scale-Self-Report (OBS-SR) for acquired brain injury: exploratory analysis of reliability and validity

Disinhibited and angry: Investigating the relationship between social disinhibition and the components of aggression following severe TBI

Social disinhibition and aggression share many similarities. But unlike with aggression, research evidence about social disinhibition following severe traumatic brain injury (TBI) is limited and treatments are missing. Establishing the association between aggression and social disinhibition would facilitate a better conceptualization of these disorders. This study aimed to determine the relationship between social disinhibition and aggression following severe TBI.In this case-control study, 25 individuals with severe TBI and 25 control participants completed the Buss-Perry Aggression Questionnaire (BPAQ), Frontal Systems Behaviour Scale (FrSBe), and Social Disinhibition Interview (SDI).Hierarchical multiple regression analyses revealed that, when controlling for covariates, the inclusion of BPAQ Anger in the model led to a 13% increase in proportion of explained variance of social disinhibition (Adjusted R2 increased from .243 to .363, p < .005). BPAQ Anger was not a significant predictor of SDI scores. Similarly, BPAQ Physical aggression scores did not contribute to the prediction of FrSBe Disinhibition or SDI scores.In conclusion, higher levels of self-reported anger (but no other components of aggression) are associated with higher levels of self-reported social disinhibition. While these findings have potential implications for the treatment of social disinhibition, further research into the possible relationship with aggression should be conducted.

Behaviour support for people with acquired brain injury within the National Disability Insurance Scheme: an Australian survey of the provider market

BACKGROUND AND OBJECTIVES

People with acquired brain injury (ABI) may experience behaviours of concern that require therapy services, including behaviour support. In Australia, the implementation of a National Disability Insurance Scheme (NDIS) and development of the NDIS Quality and Safeguards Commission, has led to significant changes to behaviour support workforce processes, and the way behaviour support is funded, regulated and delivered to people with ABI who are Scheme participants. The aim of this study was to explore the current and future provider market of professionals providing behaviour supports to Scheme participants who experience ABI.

METHOD

An anonymous survey was designed and distributed via social media channels, an email listserv and professional association newsletters to professionals working within the NDIS in Australia. Data were analysed using descriptive statistics and content analysis.

RESULTS

One hundred and two surveys responses were analysed. A majority of professionals had an average understanding of the NDIS Quality and Safeguard Commission rules and policies on behaviour support. Responses to current and future registration as an NDIS Practitioner indicated the workforce gap could increase by between 17 and 26%. Respondents also raised concerns about the lack of training and experience of allied health professional students and graduates in addressing behaviours of concern. Responses to the open-ended question highlighted additional issues in the provision of behaviour support within the NDIS.

CONCLUSIONS

This research highlighted the need for an NDIS behaviour support workforce strategy and supply-side market intervention to ensure a viable and sustainable workforce for people with ABI who need behaviour support.

Implementation of an assistive technology for meal preparation within a supported residence for adults with acquired brain injury: a mixed-methods single case study

OBJECTIVES

This study aimed to investigate the feasibility of implementing an assistive technology for meal preparation called COOK within a supported community residence for a person with an acquired brain injury.

METHODS

Using a mixed-methods approach, a multiple baseline single-case experimental design and a descriptive qualitative study were conducted. The participant was a 47-year-old woman with cognitive impairments following a severe stroke. She received 21 sessions of training on using COOK within a shared kitchen space. During meal preparation, independence and safety were evaluated using three target behaviours: required assistance, task performance errors, and appropriate responses to safety issues, which were compared with an untrained control task, making a budget. Benefits, barriers, and facilitators were assessed via three individual interviews with the client and three focus groups with the care team.

RESULTS

Both quantitative and qualitative analyses showed that COOK significantly increased independence and safety during meal preparation but not in the control task. Stakeholders suggested that the availability of a training toolkit to a greater number of therapists at the residence and installation of COOK within the client's apartment would help with successful adoption of this technology.

CONCLUSION

COOK is a promising assistive technology for individuals with cognitive deficits who live in supported community residences.Implication For RehabilitationCOOK is a promising assistive technology for cognition to increase independence and safety in meal preparation for clients with ABI within their supported living contexts.Receiving training from an expert and the availability of technical support are imperative to the successful adoption of COOK.

The Behaviour Support Elements Checklist: Profiling intervention elements in community-based behaviour support for sexualised behavior after acquired brain injury

BACKGROUND

The challenges associated with behavior dysregulation post acquired brain injury (ABI) are well documented. In a previous publication, we described a case series in which sexualized behavior post-ABI was reduced using multi-element behavior support interventions. In this publication, we describe the intervention elements used, as summarized using a one-page recording tool: The Behavior Support Elements Checklist (BSEC).

INSTRUMENT

The BSEC contains three categories indicating the target for change: the individual with ABI, their support network members, or other environmental aspects. Each category lists a number of elements being used in the routine practice of a community-based behavior support service.

RESULTS

In total, 173 intervention elements were recommended, averaging seven per participant. Elements from all three categories were routinely incorporated into interventions, but changes to the (category) environment were rated by clinicians as most effective in changing behavior; some elements (e.g., meaningful activities) were considered more effective than others (e.g., ABI education).

CONCLUSIONS

The BSEC could assist service agencies and researchers to record and analyze clinician practices to improve service delivery, detect professional development needs, and steer resource allocation. Although the BSEC reflects the context in which it was constructed, it could readily be adapted to other service contexts.

Can behaviour support interventions successfully treat inappropriate sexual behaviour after acquired brain injury in community settings? A case series (N = 24)

Inappropriate sexual behaviours (ISX) are challenging clinical sequelae of acquired brain injury (ABI). Limited evidence exists about treatment approaches, with few case studies published to date. This study reports an exploratory clinical trial of community-based behaviour support interventions as a treatment approach to ISX after ABI. From routine referrals to a state-wide service specializing in challenging behaviours after ABI, a cohort (n = 24) displaying ISXs were selected. The interventions addressed multiple behavioural domains, and used a variety of approaches including environmental change, psychoeducation, and specific behavioural techniques. These approaches targetted change in the person with ABI, support personnel, or other environmental domains. Behaviour data were collected using the Overt Behaviour Scale (OBS) at baseline, closure and follow-up. Visual inspection and multilevel models were used to analyse the data. For the sample as a whole, there was a significant decline in ISXs from baseline to closure that was maintained at follow-up. Results at an individual level are also presented. Specificity of the intervention was demonstrated by comparison with concurrent challenging behaviours (aggression, perseveration, absconding) which showed no significant change over the same three time points. The results demonstrate the potential efficacy of community-based behaviour support interventions in treating ISXs after ABI.

Re-Establishing Solid Food Consumption in a Person With Traumatic Brain Injury and Extended Food Avoidance/Restriction Using a Multicomponent Behavioral Intervention

We describe and report the results of a multicomponent behavioral intervention for re-establishing solid food consumption in a 26-year-old woman with prolonged food avoidance and restriction which developed following a traumatic brain injury. The intervention was evaluated by direct measurement of daily meal consumption over a period of several months, including an extended follow-up, and resulted in successful resumption of oral feeding. A complicating paroxysmal movement disorder resolved during treatment as well and resolution of the presenting problem led to significant quality of life improvements. We discuss the relationship of the presenting symptoms to avoidant/restrictive food intake disorder and to food rejection behavior seen when substantial damage has occurred to the parietal lobe. The case illustrates the value of assessment-based, individualized intervention design and an integrated neurobehavioral case conceptualization.

Integrated Behavioral Intervention and Person-Centered Therapy Within Community-Based Treatment of an Adult With Acquired Brain Injury

We present the case of a 30-year-old woman who had acquired brain injury (ABI) and demonstrated clinically challenging behaviors (verbally abusive outbursts toward care providers and elopement) within her community-based group home. Following a baseline phase of evaluation, she collaborated with clinicians and care providers in developing a treatment plan that included personal goal setting, differential token reinforcement, communication training, graphic performance feedback, and reinforcement fading. During 10 months of intervention, clinically challenging behaviors steadily decreased from baseline levels and low-frequency occurrence was maintained at 3-, 6-, and 9-month follow-up assessments. As the result of treatment, the woman also avoided prior psychiatric hospitalizations, enjoyed more frequent access to pleasurable activities outside her residence, and enrolled in a college course. The study illustrates an effective person-centered therapy approach combined with behavioral intervention for persons who have ABI and experience community-living adjustment difficulties.

Assessing aggression following Acquired Brain Injury (ABI): a systematic review of assessment measures

Objective: To conduct a systematic review to identify and examine the reliability and validity of standardized measures used to assess aggression in people with ABI. Data sources: Systematic searches of PsychInfo, Medline, Embase, PubMed and CINAHL databases along with hand searching of gray literature and review articles. Study selection: Studies were included if the sample had an ABI, and the measure included assessment of aggression. Data extraction: Sample and measure characteristics and psychometric properties were extracted. Measure quality was assessed using the COSMIN checklist. Data synthesis: Of 5,100 abstracts screened, 78 were reviewed in full against the inclusion and exclusion criteria, and 25 articles met the criteria for analysis. Included articles assessed the psychometric properties of 17 different measures of aggression in adults with ABI. Quality of evidence was often low. Four measures (MBPC-1990R, NFI, SASNOS and KSMS) demonstrated positive evidence of at least one psychometric property with good quality evidence. Conclusions: Although a large number of general measures were available, there are few measures that only assess post-ABI aggression, and many are not well-validated. Future research should assess the psychometric properties of these measures.