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Verhoeks C, Bus B, Tendolkar I, Rijnen S. Cognitive communication disorders after brain injury: A systematic COSMIN review of measurement instruments. Ann Phys Rehabil Med 2024; 67:101870. [PMID: 39098162 DOI: 10.1016/j.rehab.2024.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 04/08/2024] [Accepted: 05/25/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND There is a lack of consensus on standardized measurement instruments (MIs) for the assessment of cognitive communication disorders in individuals with acquired brain injury (ABI). OBJECTIVES To identify and describe the currently available MIs for the assessment of cognitive communication disorders in individuals with ABI and to evaluate the psychometric properties of MIs. METHODS A search was conducted in 6 databases on March 12, 2024 using a validated methodological search filter. We included studies that evaluated psychometric properties of MIs used to assess cognitive communication disorders in individuals with ABI. We applied the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to evaluate the psychometric properties of the MIs. RESULTS We included 48 records reporting on 44 MIs. Of all MIs, the La Trobe Communication Questionnaire (LCQ) and the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) were studied most extensively. No MIs had undergone exhaustive methodological evaluation. CONCLUSIONS Based on the COSMIN, only 1 of 44 MIs can be recommended as its results can be trusted. Most MIs have the potential to be recommended but require further research to assess their psychometric quality. The development of new tools is not necessary but further methodological studies should be conducted on promising tools. This review may help clinicians and researchers to select an MI for the assessment of cognitive communication disorders and may facilitate diagnosis and research. TRIAL REGISTRATION PROSPERO database (registration number: CRD42020196861). No funding.
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Affiliation(s)
- Carmen Verhoeks
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands; Department of Psychiatry, Radboud University Medical Center, Post office box 9101 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior. P.O Box 9104 6500 HE Nijmegen, the Netherlands.
| | - Boudewijn Bus
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Post office box 9101 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior. P.O Box 9104 6500 HE Nijmegen, the Netherlands
| | - Sophie Rijnen
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
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Fisher Z, Field S, Fitzsimmons D, Hutchings H, Carter K, Tod D, Gracey F, Knight A, Kemp AH. Group-based positive psychotherapy for people living with acquired brain injury: a protocol for a feasibility study. Pilot Feasibility Stud 2024; 10:38. [PMID: 38383489 PMCID: PMC10880369 DOI: 10.1186/s40814-024-01459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Acquired brain injury (ABI) and other chronic conditions are placing unprecedented pressure on healthcare systems. In the UK, 1.3 million people live with the effects of brain injury, costing the UK economy approximately £15 billion per year. As a result, there is an urgent need to adapt existing healthcare delivery to meet increasing current and future demands. A focus on wellbeing may provide an innovative opportunity to reduce the pressure on healthcare services while also supporting patients to live more meaningful lives. The overarching aims of the study are as follows: (1) evaluate the feasibility of conducting a positive psychotherapy intervention for individuals with ABI and (2) ascertain under what conditions such an intervention would merit a fully powered randomised controlled trial (RCT) compared to a standard control group (TAU). METHODS AND ANALYSIS A randomised, two-arm feasibility trial involving allocation of patients to either a treatment group (positive psychotherapy) or control group (treatment as usual) group, according to a 1:1 ratio. A total of 60 participants at three sites will be recruited including 20 participants at each site. Assessments will be conducted at baseline, on completion of the 8-week intervention and 3 months following completion. These will include a range of questionnaire-based measures, psychophysiology and qualitative outcomes focusing on feasibility outcomes and participant experience. This study has been approved by the Wales Research Ethics Committee (IRAS project ID: 271,251, REC reference: 19/WA/0336). DISCUSSION This study will be the first to examine the feasibility of an innovative, holistic positive psychotherapy intervention for people living with ABI, focused on individual, collective and planetary wellbeing, and will enable us to determine whether to proceed to a full randomised controlled trial. TRIAL REGISTRATION ISRCTN12690685 , registered 11th November 2020.
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Affiliation(s)
- Zoe Fisher
- Community Brain Injury Service, Morriston Hospital, Swansea, UK.
- Health and Wellbeing Academy, Swansea University, Swansea, UK.
| | - Susannah Field
- Community Brain Injury Service, Morriston Hospital, Swansea, UK
| | - Deb Fitzsimmons
- Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Hayley Hutchings
- Swansea Trials Unit, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Kym Carter
- Swansea Trials Unit, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Daniel Tod
- Swansea Trials Unit, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Fergus Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alec Knight
- King's Undergraduate Medical Education in the Community (KUMEC), Faculty of Life Sciences & Medicine, Centre for Education, GKT School of Medical Education, King's College London, London, UK
| | - Andrew H Kemp
- School of Psychology, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, UK.
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Alderman N, Williams C, Wood RL. Using the St Andrew's - Swansea Neurobehavioural Outcome Scale (SASNOS) to determine prevalence and predictors of neurobehavioural disability amongst survivors with traumatic brain injury in the community. Neuropsychol Rehabil 2022; 32:2342-2369. [PMID: 34180770 DOI: 10.1080/09602011.2021.1946092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Studies using the St Andrew's - Swansea Neurobehavioural Outcome Scale (SASNOS) confirm neurobehavioural disability (NBD) is highly prevalent in inpatient Neurobehavioural Rehabilitation and Stroke samples. However, a recent study amongst a Danish community sample of acquired brain injury survivors found a relative paucity of NBD symptoms; and when symptoms were present, they tended to be of mild severity. The current observational study employed the SASNOS to explore prevalence of NBD in survivors with traumatic brain injury (TBI) living in the community, the extent of survivors' self-awareness of NBD symptoms, and constructed prediction models of NBD. A de-identified data set was compiled, comprising data for 97 TBI survivors (74.2% men, mean time since injury 2.8 years). In addition to SASNOS self- and proxy-ratings, various demographic, clinical and injury-related characteristics were captured. NBD was found to be highly characteristic, although severity varied depending on subtype. Statistical comparison of self- and proxy-ratings did not support reduced self awareness regarding NBD, whereas treating the problem as one of inter-rater reliability suggested this was an issue. Executive impairment, depressed mood and sex were especially prognostic of NBD. Reasons accounting for differences in NBD between the community samples are discussed and recommendations for future research made.
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Affiliation(s)
- Nick Alderman
- Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, Swindon, UK.,Department of Psychology, Swansea University, Swansea, UK
| | - Claire Williams
- Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, Swindon, UK.,Department of Psychology, Swansea University, Swansea, UK
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Stolwyk RJ, Low T, Gooden JR, Lawson DW, O’Connell EL, Thrift AG, New PW. A longitudinal examination of the frequency and correlates of self-reported neurobehavioural disability following stroke. Disabil Rehabil 2020; 44:2823-2831. [DOI: 10.1080/09638288.2020.1840637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Renerus J. Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Tiffany Low
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - James R. Gooden
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - David W. Lawson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Elissa L. O’Connell
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Cheltenham, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Peter W. New
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Cheltenham, Australia
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Clayton, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
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Palmisano S, Fasotti L, Bertens D. Neurobehavioral Initiation and Motivation Problems After Acquired Brain Injury. Front Neurol 2020; 11:23. [PMID: 32153486 PMCID: PMC7049782 DOI: 10.3389/fneur.2020.00023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022] Open
Abstract
Motivation is a primary and permanent source of human behavior and adaptation. Motivational deficits, along with deficiencies in initiation, frequently occur in individuals with acquired brain injury (ABI). These neurobehavioral problems are associated with consequences at the participation level: patients are reluctant to engage in rehabilitation, and their subsequent social reintegration is often at risk. The same problems may also become a heavy burden for the families of individuals with ABI. In the present paper, we will critically review both the current definitions and the instruments used to measure motivational disorders following ABI. We will also describe the neural system underlying motivation and its impairments. What emerges is the need to develop specific rehabilitative treatments, still absent at the moment, with the ultimate aim of ensuring a better quality of life for both the patients and their proxies.
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Affiliation(s)
- Simona Palmisano
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
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6
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Whitwham S, Jones KA. Assessing aggression following Acquired Brain Injury (ABI): a systematic review of assessment measures. Brain Inj 2019; 33:1491-1502. [PMID: 31449427 DOI: 10.1080/02699052.2019.1655795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Stephanie Whitwham
- Division of Psychiatry and Applied Psychology, University of Nottingham , Nottingham , UK
| | - Katy A Jones
- Division of Psychiatry and Applied Psychology, University of Nottingham , Nottingham , UK
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O’Connell EL, Lawson DW, New PW, Stolwyk RJ. Agreement between patients and nurses of neurobehavioral disability following stroke in an inpatient rehabilitation setting. Disabil Rehabil 2019; 42:2868-2875. [DOI: 10.1080/09638288.2019.1572792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elissa L. O’Connell
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Melbourne, Australia
| | - David W. Lawson
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Peter W. New
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Melbourne, Australia
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Renerus J. Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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Alderman N, Pink AE, Williams C, Ramos SDS, Oddy M, Knight C, Jenkins KG, Barnes MP, Hayward C. Optimizing measurement for neurobehavioural rehabilitation services: A multisite comparison study and response to UKROC. Neuropsychol Rehabil 2019; 30:1318-1347. [DOI: 10.1080/09602011.2019.1582432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nick Alderman
- Elysium Neurological Services, Elysium Healthcare, Badby Park, Daventry, UK
- Department of Psychology, Swansea University, Swansea, UK
| | - Aimee E Pink
- Department of Psychology, Swansea University, Swansea, UK
- Independent Neurorehabilitation Providers Alliance, UK
| | | | | | - Michael Oddy
- Brain Injury Rehabilitation Trust, The Disabilities Trust, Burgess Hill, UK
| | - Caroline Knight
- The Oakleaf Group, Northampton, UK
- School of Psychology, University of Leicester, Leicester, UK
- Elysium Neurological Services, Elysium Healthcare, St Neots Hospital, Cambridge, UK
| | - Keith G Jenkins
- National Brain Injury Centre, St Andrew’s Healthcare, Northampton, UK
| | | | - Chloë Hayward
- Independent Neurorehabilitation Providers Alliance, UK
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Soendergaard PL, Siert L, Poulsen I, Wood RL, Norup A. Measuring Neurobehavioral Disabilities Among Severe Brain Injury Survivors: Reports of Survivors and Proxies in the Chronic Phase. Front Neurol 2019; 10:51. [PMID: 30804873 PMCID: PMC6370614 DOI: 10.3389/fneur.2019.00051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/15/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Neurobehavioral disability (NBD) has a major influence on long-term psychosocial outcome following acquired brain injury, as it affects not only the survivor of the brain injury, but the whole family. Objectives: To investigate (1) the frequency of NBD among survivors of severe brain injury measured by the Danish version of the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) rated by patients and proxies, (2) factors associated with NBD, and (3) concordance between reports of NBD completed by patients and proxies. Methods: SASNOS was administered at an outpatient unit as a part of a follow-up assessment after discharge from intensive neurorehabilitation. SASNOS consists of five factors describing the following domains: Interpersonal Behavior, Cognition, Aggression, Inhibition and Communication, and both the patient and a proxy were asked to complete the questionnaire. Data collection was conducted over a period of 2 years, and 32 patients and 31 proxies completed the questionnaire. Mean time since injury was 19.4 months (10.0 SD). Most patients were male (68.8%), and most proxies were female (58.1%). Most of the patients had suffered a traumatic brain injury (68.8%). Results: A fourth of this patient group reported themselves below the normal range on the major domains of Interpersonal Behavior and Cognition. Significant associations between proxies' reports and time since injury, cohabitant status, and the patient's score on the Extended Glasgow Outcome Scale were found. Furthermore, significant differences were found between patient and proxy ratings. Proxies rated patients as having fewer problems on the Interpersonal Behavior domain, and more problems in relation to Cognition. Cognition was the only domain, where patients rated themselves higher indicating fewer problems, compared with their proxies. On both the Aggression and Communication domains, proxies rated patients higher indicating fewer problems than the patients themselves. Conclusion: Danish brain injury survivors experienced NBD as measured by SASNOS. Differences were found between patient and proxy ratings in relation to Cognition and Interpersonal Behavior. The NBDs identified can affect the survivor's ability to reintegrate and participate in activities of daily living, emphasizing how a systematic assessment is required.
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Affiliation(s)
- Pernille Langer Soendergaard
- Department of Neurology, Rigshospitalet, Glostrup, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Lars Siert
- RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Rigshospitalet, Hvidovre, Denmark
| | - Ingrid Poulsen
- RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Rigshospitalet, Hvidovre, Denmark.,Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
| | - Rodger Ll Wood
- Swansea University, Institute of Life Sciences, College of Medicine, Swansea, United Kingdom
| | - Anne Norup
- Department of Neurology, Rigshospitalet, Glostrup, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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10
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Alderman N. Challenges and importance of measuring neurobehavioural disability in acquired brain injury: the 'St Andrew's Swansea - Neurobehavioural Outcomes Scale' (SASNOS). Expert Rev Neurother 2018; 18:807-810. [PMID: 30277093 DOI: 10.1080/14737175.2018.1531705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nick Alderman
- a Neurobehavioural Rehabilitation Services , Elysium Neurological , Badbury , Northants
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Stolwyk RJ, O'Connell E, Lawson DW, Thrift AG, New PW. Neurobehavioral disability in stroke patients during subacute inpatient rehabilitation: prevalence and biopsychosocial associations. Top Stroke Rehabil 2018; 25:1-8. [PMID: 30213238 DOI: 10.1080/10749357.2018.1499301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES There are scarce data on post-stroke neurobehavioral disability (NBD). The aim of this study was to identify the prevalence of NBD in a subacute inpatient stroke population and examine potential associations with demographic, stroke-related, functional and psychosocial variables. METHODS 82 survivors of stroke were consecutively recruited during their inpatient rehabilitation admission. Nursing staff rated NBD in patients using the St Andrews -Swansea Neurobehavioral Outcome Scale (SASNOS). Measures of patient functional independence (FIM), cognition (MoCA), and mood symptoms (HADS) were collected in addition to nursing reports of whether observed NBD negatively impacted on the patient or those around them. RESULTS NBD relating to interpersonal relationships (44.4% of participants) and cognition (52.4%) were highly prevalent within the sample while NBD relating to inhibition (1.2%), aggression (3.6%), and communication (2.5%) were relatively rare. Presence of NBD was significantly associated with reduced functional independence (rs=0.39, p < 0.01) and associated with trends in cognitive impairment (rs=0.29, p = 0.03), increased anxiety (rs=-0.43, p = 0.02) and depressive symptoms (rs=-0.43, p = 0.02). Presence of NBD was significantly correlated with negative impact to the patient and those around them across all SASNOS domains (rs range 0.42 - 0.45, all p ≤ 0.01). CONCLUSIONS NBD is common within a subacute stroke inpatient population, particularly interpersonal and cognitive difficulties and preliminary analyses indicate associations with reduced functional ability, cognition and mood. There is a need to provide education and support to clinicians to facilitate routine assessment and management of NBD following stroke.
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Affiliation(s)
- Renerus J Stolwyk
- a Monash Institute of Cognitive and Clinical Neurosciences , School of Psychological Sciences, Monash University , Melbourne , Victoria , Australia
- b Monash-Epworth Rehabilitation Research Centre , Melbourne , Victoria , Australia
| | - Elissa O'Connell
- c Rehabilitation and Aged Care Services , Medicine Program, Monash Health , Melbourne , Australia
| | - David W Lawson
- a Monash Institute of Cognitive and Clinical Neurosciences , School of Psychological Sciences, Monash University , Melbourne , Victoria , Australia
- b Monash-Epworth Rehabilitation Research Centre , Melbourne , Victoria , Australia
| | - Amanda G Thrift
- d Department of Medicine, School of Clinical Sciences at Monash Health , Monash University , Melbourne , Victoria , Australia
| | - Peter W New
- e Epworth-Monash Rehabilitation Medicine Unit , Monash University , Melbourne , Victoria , Australia
- f Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
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Rasch Analysis, Dimensionality, and Scoring of the Neuropsychiatric Inventory Irritability and Aggression Subscales in Individuals With Traumatic Brain Injury. Arch Phys Med Rehabil 2018; 99:281-288.e2. [DOI: 10.1016/j.apmr.2017.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022]
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Alderman N, Williams C, Wood RL. When normal scores don’t equate to independence: Recalibrating ratings of neurobehavioural disability from the ‘St Andrew’s – Swansea Neurobehavioural Outcome Scale’ to reflect context-dependent support. Brain Inj 2017; 32:218-229. [DOI: 10.1080/02699052.2017.1406989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nick Alderman
- Elysium Neurological, Badby Park, Daventry, Northants
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Claire Williams
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rodger Ll. Wood
- Neuropsychology Clinic, College of Medicine, Swansea University, Swansea, UK
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Alderman N, Williams C, Knight C, Wood RL. Measuring Change in Symptoms of Neurobehavioural Disability: Responsiveness of the St Andrew's-Swansea Neurobehavioural Outcome Scale. Arch Clin Neuropsychol 2017; 32:951-962. [DOI: 10.1093/arclin/acx026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/15/2017] [Indexed: 11/12/2022] Open
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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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O'Neill B, Findlay G. Single case methodology in neurobehavioural rehabilitation: Preliminary findings on biofeedback in the treatment of challenging behaviour. Neuropsychol Rehabil 2014; 24:365-81. [DOI: 10.1080/09602011.2014.915856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Brodtmann A, Werden E, Pardoe H, Li Q, Jackson G, Donnan G, Cowie T, Bradshaw J, Darby D, Cumming T. Charting Cognitive and Volumetric Trajectories after Stroke: Protocol for the Cognition and Neocortical Volume after Stroke (CANVAS) Study. Int J Stroke 2014; 9:824-8. [DOI: 10.1111/ijs.12301] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 05/07/2014] [Indexed: 11/30/2022]
Abstract
Rationale Globally, stroke and dementia are leading causes of disability and mortality. More than one third of stroke patients will develop dementia, but mechanisms are unclear. Aims The study aims to establish whether brain volume change is associated with poststroke dementia, and to elucidate potential causal mechanisms, including genetic markers, amyloid deposition and vascular risk factors. An understanding of whether – and in whom – stroke is neurodegenerative is critical for the strategic use of potential disease-modifying therapies. Hypotheses That stroke patients will exhibit greater brain volume loss than comparable cohorts of stroke-free controls; and that those who develop dementia will exhibit greater brain volume loss than those who do not. Design Advanced brain imaging techniques are used to longitudinally measure brain volume and cortical thickness in 135 stroke patients. Concurrent neuropsychological testing will correlate clinical profile with these measures. Primary outcomes Primary imaging end-point is brain volume change between three-months and three-years poststroke; primary clinical outcome is the presence of dementia at three-years. Secondary outcomes We will examine the correlations with the following variables: dementia subtype; physical activity levels; behavioral dysfunction as measured by patient and caregiver-reported scales; structural and functional brain connectivity disruption; apolipoprotein E; and specific neuropsychological test scores. Discussion Magnetic resonance imaging markers of structural brain aging and performance on neuropsychological tests are powerful predictors of dementia. We need to understand the trajectory of regional brain volume change and cognitive decline in patients after stroke. This will allow future risk stratification for prognostic counseling, service planning, and early therapeutic intervention.
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Affiliation(s)
- Amy Brodtmann
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
- Austin Health, Heidelberg, Melbourne, Vic., Australia
- Eastern Clinical Research Unit, Monash University, Box Hill Hospital, Melbourne, Vic., Australia
| | - Emilio Werden
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
| | - Heath Pardoe
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Qi Li
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
| | - Graeme Jackson
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
- Austin Health, Heidelberg, Melbourne, Vic., Australia
| | - Geoffrey Donnan
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
| | - Tiffany Cowie
- The Centre for Translational Pathology, University of Melbourne, Melbourne, Vic., Australia
| | | | - David Darby
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
- Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Toby Cumming
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
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18
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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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