Acquired Brain Injury Case Study – an example of how SASBA can be utilised in clinical work (part 1)
The patient
BS, a married man in his early fifties who owned his own business, incurred a traumatic brain injury as a result of a fall. On admission to hospital, the Glasgow Coma Scale index was 3; CT scan revealed a left frontal subdural haematoma. After several months in hospital, BS was discharged home into the care of his family. Unfortunately, his behaviour deteriorated to the point that he could no longer be maintained in the community. As a consequence, he was admitted into a neurorehabilitation service for assessment and treatment. Neuropsychological investigation demonstrated that BS had a range of executive function impairments, including difficulties with attention, self-monitoring, planning and error-utilisation. Particularly notable was his lack of inhibitory control; he would frequently say the first thing that came to mind, or carry through whatever urge he experienced, without any appreciation of the appropriateness or consequences of such actions. His memory was poor and insight into his current difficulties was impaired. BS also had rehabilitation needs regarding physical function and his ability to undertake activities of daily living. It was the view of the professionals charged with his care that he could make progress by engaging in rehabilitation. Unfortunately, his behaviour prevented him from doing so.
Assessment Using SASBA
During the first two weeks of admission, BS was encouraged to engage in assessment and rehabilitation sessions. His behaviour was closely monitored and recorded by staff using, amongst a range of observational measures, SASBA. On completion of this initial assessment period, SASBA and other behaviour recordings were collated and analysed, and discussed at a case review by the multidisciplinary team (MDT). As well as aggression, SASBA recordings were made during this period, highlighting to the team the presence of a number of potentially inappropriate sexual behaviours. Figure 1 shows how often each of the behaviour categories of SASBA was observed, and the severity of these behaviours. ‘Exposure’ (E) was not apparent. Seven ‘Verbal Comments’ (VC) and 10 ‘Non Contact’ (NC) behaviours were recorded. As can be seen in Figure 1, most of these behaviours were categorised as ‘mild’ in severity. Discussion of these data by the MDT confirmed recordings reflected that BS made over-familiar comments towards female staff and stared at them occasionally. SASBA demonstrated that all of these behaviours had been ‘played down’ and it was agreed by the MDT that not responding to these, whilst encouraging appropriate social interaction with BS, was the treatment approach that should be maintained.
However, SASBA recordings for the fourth category of behaviour captured by the scale, ‘Touching Others’ (TO), highlighted a behaviour that increased risk both to BS and others, and which some staff found especially distressing. Thirty seven TO’s had been observed. As well as being more numerous than the VC and NC behaviours, it was also potentially more harmful to others. Figure 1 shows that 30% of these events were categorised as ‘very severe’. Discussion of this data by the MDT confirmed that BS had frequently attempted intimate contact with female staff, behaviour that many understandably found upsetting and uncomfortable. Some members of the MDT felt they had been deliberately targeted by BS as recipients for this behaviour, and as a consequence tried to avoid him whenever possible. In addition, SASBA recordings showed that whilst the frequency of VC and NC had fallen in the second week of the assessment period, TO had increased, which was clearly a worrying trend and one that the MDT wished to reverse.
Part 2 >