Using proven measures of psychological, functional and independence assessment, such as FIM+FAM, SASNOS and OAS-MNR, we tracked key aspects of behaviour, alongside functional and cognitive change (such as personal hygiene and daily living management) for 11 patients who were admitted to Tallis and progressed through our ABI pathway for between 9 and 12 months. Patients had been referred from other providers where aggression had previously escalated or where patients had failed to engage in therapeutic programmes and the placement subsequently broke down.
reduction in the incidents of behaviours that challenge
reduction in the severity of incidents
improvement in FIM+FAM outcomes
improvement in SASNOS
A neurobehavioural study: Converting behaviour that challenges in to engagement
People admitted to Tallis ABI unit typically present with behaviours that can be challenging for rehabilitation services. These combine with co-morbid physical and mental health diagnoses which manifest as physical and verbal aggression that is difficult to manage within local or regional units.
This study demonstrates how the unique neurobehavioural rehabilitation approach developed by St Andrew’s national Neuropsychiatry service is interwoven with Positive Behaviour Support (PBS) plans to enable patients to engage in their recovery.
Overt Agression Scale - modified for neurorehabilitation (OAS-MNR). It was developed at St Andrew’s to standardise the method of describing and reporting of overt aggression exhibited by patients, and has a long history of use across our pathways.
Functional Independence Measure (FIM) is a global measure of disability and can be scored alone or with the additional 12 items that formulate the Functional Assessment Measure (FAM). FAM does not stand alone, hence the abbreviation of FIM+FAM.
St Andrew’s Swansea Neurobehavioural Outcome Scale (SASNOS) is a neurobehavioural disability measure that uses rating scales to produce indices of disability. Unlike other measures it has been conceptualised and designed specifically for brain injury, has sufficient items to capture the diversity of neurobehavioural disability and has known, robust psychometric properties on 49 items and five major domains of neurodisability.
Aggregate Aggression Score (AAS) Frequency of aggression alone does not reflect potential change in either type of aggressive behaviour or its severity. Frequency may not change but differences in the type and severity may reflect positive clinical progress. The AAS reflects the variable elements of aggression by calculating frequency multiplied by the mean weighted severity *.
* Median values were used because the data is not normally distributed. Further information on AAS can be found in ‘Measuring behavioural outcome in neurodisability’, 2012, Alderman, Knight, Stewart and Gayton, St Andrew’s Healthcare
With over 460 specialist Neuropsychiatry staff we deliver truly tailored care to adults with the most complex, acquired or progressive neurological conditions, alongside their co-morbid physical needs and mental health disorders.
Over the past four decades we have pushed the boundaries of what is possible in neurobehavioural treatment and rehabilitation by repeatedly transforming complex behaviour in to user engagement and goal-fulfilment. We treat the individual, not just the condition, and provide gender-specific units dedicated to those with;
With a pathway of over 200 beds, from medium secure through to community-supported transitional living, we can tailor the environment, therapy and vocational support to each patients' needs.
For further information on our services and Neurobehavioural approach please contact Freephone 0800 434 6690 or email us on [email protected]