OAS-MNR

Aggression as a symptom of neurobehavioural disability is a frequent and long-term sequelae of acquired and traumatic brain injury (TBI). Aggressive behaviour after head injury inflicts significant stress within families and can adversely affect community reintegration. A tendency for aggression to increase over time amongst people with TBI has been reported. It can result in admission to hospital, is associated with poor outcome, and may lead to exclusion from rehabilitation altogether.  As a consequence, there is a tendency for people to gravitate to unsuitable facilities for the purpose of long term management rather than brain injury rehabilitation. As a consequence, it has proved necessary to develop specialised ‘Neurobehavioural rehabilitation’ services to meet the needs of this complex and challenging group of patients. In some cases admission to such services, is the only viable option for patients who present with severe, persisting behaviour problems, including aggression. The National Brain Injury Centre pioneered the development of services for people with acquired brain injury and challenging behaviour and continues be at the cutting edge regarding the management of such patients.

Aggressive behaviour as a consequence of brain injury has complex origins. Observable alterations in behaviour are partly the product of interaction between damaged neural systems and pre-morbid personality traits. However, it is recognised that the environment has a significant impact on aggression: understanding and identifying what factors maintain or encourage this behaviour can result in interventions that remediate it.

However, reliable estimates of the actual prevalence of aggressive behaviour as a consequence of ABI remain elusive; a recent survey found reports of aggression amongst traumatic brain injury survivors varied from 11-96% [1]. This enormous variability between different studies has been attributed to the use of inconsistent terminology and lack of appropriate recording tools.

As a consequence, Alderman, Knight and Morgan [2] developed the Overt Aggression Scale – Modified for Neurorehabilitation’ (OAS-MNR) in order to introduce a standardised method of describing and reporting aggression exhibited by patients primarily participating in residential neurorehabilitation programmes. This was a modification of the ‘Overt Aggression Scale’ (OAS) that had been proposed by Yudofsky and colleagues [3]. The principal modifications made to the OAS to produce the OAS-MNR were to make the instrument more relevant to use within neurorehabilitation settings by adding setting events and antecedents, increasing the range of interventions used to manage behaviour, and develop the documentation required to support it. Psychometric properties for the scale were also determined. Using the OAS-MNR, a set of codes can be used as a shorthand means of capturing objective detail regarding potentially complex sequences of behaviour.

Further information >