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    ABI-Study
Arrow ImageAcute, PICU and Rapid Response

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.

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  • Summary

    • Reduce
    • Re-engage
    • Rebuild
    • Rehabilitate
    full-graph-with-layer-groups-v3 ADMISSION REDUCE & RE-ENGAGE Median rating used for each measurement REBUILD REHABILITATE 200 100 200 300 400 500 600 700 800 160 180 140 120 100 80 60 40 20 0 0-3 months 4-6 months 7-9 months 10-12 months AAS score OAS-MNR - FIM+FAM - SASNOS
    • 82.54%

      reduction in the incidents of behaviours that challenge

    • 79.26%

      reduction in the severity of incidents

    • 20.43%

      improvement in FIM+FAM outcomes

    • 14.23%

      improvement in SASNOS

    • Reduce
    • Re-engage
    • Rebuild
    • Rehabilitate

    REsearch into behaviours that challenge

    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.

  • An outline of the tools used:

    • 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

  • Admission

    5,858
    individual incidents of aggression in the first 3 months

    20,871
    Average Aggression Score (AAS) highlighted significant difficulty in self regulation

    142
    median FIM+FAM rating evidencing reduced funtional independence on admission

    full-graph-with-layer-groups-v3 ADMISSION REDUCE & RE-ENGAGE Median rating used for each measurement REBUILD REHABILITATE 200 100 200 300 400 500 600 700 800 160 180 140 120 100 80 60 40 20 0 0-3 months 4-6 months 7-9 months 10-12 months AAS score OAS-MNR - FIM+FAM - SASNOS

    Admission and Stabilisation

    • During the first 3 months of admission we recorded 5,858 incidents of aggressive verbal or physical behaviours across the 11 patients, with a median rate of 189.
    • Using the OAS-MNR we categorised the severity of each incident to create an Aggregate Aggression Score value which totalled 20,871, or a median of 699, reflecting significant difficulty in self-regulation and modulation among this population
    • During the same period the FIM+FAM median rating was only 142 evidencing reduced functional independence, and SASNOS was 35.1 highlighting executive dysfunction and low ability in performing often simple tasks.

  • ReDuce

    Re-Engage

    47.35%
    reduction in the number of aggressive incidents

    47.72%
    reduction in the severity of incidents

    8.45%
    improvement in functional ability

    full-graph-with-layer-groups-v3 ADMISSION REDUCE & RE-ENGAGE Median rating used for each measurement REBUILD REHABILITATE 200 100 200 300 400 500 600 700 800 160 180 140 120 100 80 60 40 20 0 0-3 months 4-6 months 7-9 months 10-12 months AAS score OAS-MNR - FIM+FAM - SASNOS

    Engaging in therapy

    • Overt aggression dramatically reduced among patients during the second phase of treatment to 3,084 incidents, with a median of 109
    • The AAS score, which measures the severity of each incident, fell by 47.72% compared to the first period of care, as tailored intervention strategies incorporating RAID®, neurobehavioural programmes and a structured therapeutic milieu, helped staff and patients to recognise triggers and begin to adapt behaviours.
    • FIM+FAM measurements improved by over 8.5% as greater engagement in therapy contributed to more functional improvements in recovery.

  • ReBuild

    27.1%
    reduction in total aggressive incidents (-5.5% median)

    49.62%
    further reduction in median severity

    11.04%
    improvement in median FIM + FAM rating

    full-graph-with-layer-groups-v3 ADMISSION REDUCE & RE-ENGAGE Median rating used for each measurement REBUILD REHABILITATE 200 100 200 300 400 500 600 700 800 160 180 140 120 100 80 60 40 20 0 0-3 months 4-6 months 7-9 months 10-12 months AAS score OAS-MNR - FIM+FAM - SASNOS

    Building on early progress

    • The total number of incidents reduced a further 27% and the median score was 103 (-5.5%) as patients continued to experience new aspects of therapy and test their recovery. This highlights the consequences of higher expectations as patients adjust to lesser structure as they moved to new environments in the pathway which can cause a temporary resurgence of earlier anxieties.
    • Crucially our staff enabled the severity total to continue to fall to 7,427.
    • FIM+FAM measurements continued to improve, achieving a median rate of 171 compared to 142 on admission, an 11% improvement compared to period 2, supported by a range of additional vocational opportunities.

  • ReHabilitate

    67.96%
    improvement in incidents of avert aggression

    8.3%
    FIM + FAM median improvement compared to third period

    SASNOS rating of
    40

    full-graph-with-layer-groups-v3 ADMISSION REDUCE & RE-ENGAGE Median rating used for each measurement REBUILD REHABILITATE 200 100 200 300 400 500 600 700 800 160 180 140 120 100 80 60 40 20 0 0-3 months 4-6 months 7-9 months 10-12 months AAS score OAS-MNR - FIM+FAM - SASNOS

    Continuous rehab, and progression through the pathway

    • On final recording the OAS median achieved 33, or a 67.97% reduction from phase 3, highlighting continuous development and improvement. The AAS severity median also fell significantly in this phase reflecting the transition from aggression to goal fulfilment and participation.
    • FIM+FAM improved in total during the study, with the final period median rising from 171 to 185, despite several patients having left the service at this point
    • SASNOS median improvements settled at 40 following the initial phase of 35.1, an improvement of 13.96%
    • By the fourth phase only two patients remained on Tallis, with the remainder having progressed through the St Andrew’s pathway to community or slow-stream rehab, or discharged.
    • Reduce
    • Re-engage
    • Rebuild
    • Rehabilitate

    St Andrew’s Neuropsychiatry service

    Using Research as a catalyst for change

    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;

    • Acquired / Traumatic brain injury
    • Complex dementia
    • Huntington’s disease

    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 enquiries@standrew.co.uk