Moderate to severe brain injury (BI) can result in a wide range of deficits in all human capacities: physical, cognitive, emotional, behavioural and /or social, indifferent of the cause of the injury.
In daily life, physical disturbances like fatigue, sleeping disorders, immobility, or sensory deficits can have great influence on all activities. The most important consequences for the cognition are deficits in alertnes and attention, memory problems, delayed speed of information processing, language disorders, or troubled executive functions like planning or problem solving. The most important consequences in behaviour and social-emotional functions are lack of initiative, lack of motivation, impulsivity, loss of control, aggression, irritability, lack of social sens, mood swings, egocentricity, sexual impulsivity, vulnerability for addiction, or symptoms of depreesion, anxiety disorder, bipolar disorder, or psychosis.
The consequences of brain injury can be seen in all possible combinations and intensity. Especially, the behavioural and/or sococial-emotional consequences can result in disruptive behaviour, sometimes resulting in the need for admittance to special clinical settings in order to be able to handle the behaviour. The majority of health care institutions lack the ability to control for disruptive behaviour.
GGZ Oost Brabant, Huize Padua, manages a special care service for patients with disruptive behaviour caused by acquired brain injury. The special treatments can be characterized by the non-challenging environment and programme, by the tailormade individual-adapted approach and by the prescription of 'off-label' medication. For instance, a dopamine agonist like Amantadine or a stimulant like Methylphenidate can be prescribed in order to regulate underlying disrupted attentional mechanisms. Also mood regulating drugs like Valproic Acid, Carbamzapine or Lithium can be prescribed for regulating irritative behaviour.
Recently, a research project has started in order to evaluate the treatments for BI-patients. Due to the very small numbers of patients it is impossible to form groups of patients and control groups in order to execute a group-controlled research design. It has been decided to make use of single-case research designs. The precise design has to be determined in each individual, dependent on the behaviour problems, on the given treatment, and on the possibilities for measuring changes in the behaviour.
The aim is to match as much as possible the criteria for executing proper single case studies, as formulated in the Single Case Experimental Design scale (Tate, R.L., et al., Rating the methodological quality of single-subject designs and n-of-1 trials: introducing the Single-Case Experimental Design (SCED) Scale. Neuropsychological Rehabilitation, 2008. 18(4): p. 385-401).
The research project has started on the first of January 2010, after preparing for more than a year. Some pilot studies were executed in order to find out what are the best ways executing the study. Some of these pilots have been presented on a Poster during the two-yearly congres of the International Brain Injury Association from 10-14 March 2010 in Washington (see: https://www.internationalbrain.org/?q=node/16).
The Poster can be seen on: Poster Henk Eilander
More information will be presented at the end of 2010.
Contact
GGZ Oost Brabant
NaH Huize Padua, Henk J. Eilander, PhD
Clinical neuropsychologist /researcher
h.eilander@ggzoostbrabant.nl
