In Individual Clinical Work
The OAS-MNR has research applications and there are numerous examples of how it has been employed for this purpose in the brain injury literature. However, it was primarily designed for use in individual clinical work with service users. Figure 1 illustrates an example of this, showing how it contributes towards understanding what maintains aggression and in determining rehabilitation outcome at the level of the individual service user.
Figure 1: OAS-MNR data showing a reduction in LM’s aggressive behaviour
LM was a 34 year old male who had sustained multiple injuries as a result of a road traffic accident; this included a traumatic brain injury which was classified as ‘very severe’ from duration of coma and loss of consciousness. Subsequent attempts at post-acute rehabilitation regarding a range of impairments that undermined LM’s ability to resume participation in activities he undertook prior to injury were unsuccessful because of frequent and severe physical assaults he made against other people. As a consequence, he was admitted to the National Brain Injury Centre to receive specialist neurobehavioural rehabilitation.
All aggression captured by the OAS-MNR is routinely recorded by the clinical teams within NBIC from admission to discharge. During the first two weeks, expectations regarding LM’s participation in the rehabilitation programme were low, giving him an opportunity to settle in and for the clinical team to make a preliminary assessment of his needs. This included a review of his medication and the withdrawal of the drug regime previously maintained for its sedative effects. From the third week of admission, LM was encouraged to participate in a rich and varied individual programme designed to meet his specific requirements.
A range of meaningful and relevant outputs were derived form the OAS-MNR during this time. Ninety seven episodes of aggression were recorded over seven weeks. These comprised verbal aggression and physical aggression against other people; consistent with his pre-admission history, the majority were physical assaults against others (72%); 60% of incidents were classified as ‘severe’ using the criteria within the scale.
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