SASNOS

Neurobehavioural Rehabilitation, Collaboration and the Development of a New Outcome Measure

St Andrew’s National Brain Injury Centre (NBIC) and Swansea University collaborated in a four year project to create the ‘St Andrews-Swansea Neurobehavioural Outcome Scale’ (SASNOS).

Neurobehavioural disability (NBD) has a major impact on long-term psychosocial outcome following acquired brain injury (ABI). It is a term that describes a complex, subtle, pervasive constellation of cognitive-behavioural changes that characterise post-acute ABI. Emotional difficulties, problems with inhibition, intolerance, poor insight, lack of awareness and aggressive behaviour can all be symptomatic. NBD undermines social independence and is associated with poor prognosis. However, assessing and quantifying NBD remains elusive. A review published in the journal Brain Injury in 2008 highlighted that a reliable, valid measure to adequately capture the subtle, varied characteristics of NBD had yet to be developed.

The SASNOS is similar to existing NBD measures in that it uses rating scales to produce indices of disability. However, unlike other measures it has been conceptualised and designed specifically for ABI, has sufficient items to capture the diversity of NBD, and has known, robust psychometric properties. Patients are rated by clinical teams on 49 items which measure five major domains of NBD; each has 2-3 sub-domains. Standardised scores are computed so domains can be compared. Initial ratings can be used as a baseline to track progress in rehabilitation and help clinicians with setting goals. Ratings can also be compared with those of neurologically healthy people.

SASNOS is completed on admission to St Andrew’s and at three month intervals thereafter. It provides clinicians and researchers with an effective tool for measuring rehabilitation and other outcomes, whilst its psychometric credentials enable it to be used as a measure of service efficacy. The academic paper underpinning the development work undertaken to create and validate SASNOS will be published in the journal Brain Injury, whilst the scale is available to download here.

It is a mistake to believe that people with acquired brain injury and challenging behaviour can be effectively managed in non-specialist services. Best practice advocates that admission to specialised neurobehavioural rehabilitation units is required, and in addition to the clinical benefits provides the most cost-effective solution in the medium-to-long term. For over three decades, clinicians from NBIC have demonstrated that even the most challenging people with brain injury can be helped and the quality of life for their families and themselves improved.