Positive behaviour support for challenging behaviour after acquired brain injury: An introduction to PBS + PLUS and three case studies

Gould, Kate Rachel; Ponsford, Jennie; Hicks, Amelia J.; Hopwood, Malcolm; Renison, Belinda; Feeney, Timothy J.

doi:10.1080/09602011.2019.1656647

Cited by 23 publications

(15 citation statements)

References 47 publications

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“…The reward in this case was often positive feedback, such as praise or congratulating patients on their strengths. This is considered a form of antecedent‐focussed emotion regulation (AFER) and aligns with a positive behaviour support (PBS) approach (Gould et al, 2021; Horton et al, 2022). PBS has been shown to elicit desired behaviours after ABI and AFER prompts a mirrored emotional response when conversing (ibid).…”

Section: Discussionmentioning

confidence: 99%

“…PBS has been shown to elicit desired behaviours after ABI and AFER prompts a mirrored emotional response when conversing (ibid). This dyadic way of relating is delicate, yet it plays a powerful role in enhancing occupational participation in patients with BoC after ABI (Côté, 2005; Gould et al, 2021). In summary, building safe rapport was used to develop trust and psychological safety when addressing BoC in this study.…”

Section: Discussionmentioning

confidence: 99%

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Neuro‐behavioural changes after acquired brain injury: The role of the occupational therapist; the interventions they use and why

Brown,

Tse,

Fortune

2023

Aus Occup Therapy J

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IntroductionAlmost half of the people living with acquired brain injury experience behavioural changes, yet there is lack of clarity both in the literature, and through major stakeholders internationally, regarding how occupational therapists contribute to neuro‐behavioural rehabilitation and what their role is in this context.MethodsThis study answers the research question: What do occupational therapists perceive as their role in behavioural rehabilitation with adults living with acquired brain injury, and what treatment approaches, if any, are they using to promote occupation? A national, qualitative, bounded case study design using semi‐structured interviews was used to explore what the role of the occupational therapist is in neuro‐behavioural rehabilitation across subacute brain injury units in Australia.FindingsFour themes were identified which provide clarification on the role of the occupational therapist in neuro‐behavioural rehabilitation: You change the task, you change the environment, change the person; build a safe rapport; the sensory stuff is huge and, finally, owning how we think.ConclusionThis bounded case study provides insight into how occupational therapists perceive their role and the interventions they use to promote occupational engagement. The lack of recognition of the occupational therapist role is a barrier to providing appropriate neuro‐behavioural rehabilitation. This case study identified sensory approaches, building safe rapport and adapting the environment as the main interventions used in neuro‐behavioural rehabilitation by occupational therapists.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neuro‐behavioural changes after acquired brain injury: The role of the occupational therapist; the interventions they use and why

Brown,

Tse,

Fortune

2023

Aus Occup Therapy J

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“…However, this review highlights the lack of empirical evidence to support these approaches. While behavioural approaches have a stronger evidence base in patients with TBI in the more chronic phase (Gould et al, 2021 ; Sloan, 2017 ; Ylvisaker et al, 2007 ), these may not translate to patients in PTA, given their significant cognitive impairments which can impact on the types of approaches that can be effective. In the studies included in this review, behavioural strategies often involved antecedent modification, where triggers of agitation are identified and removed or modified.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Non-Pharmacological Interventions for Agitation during Post-Traumatic Amnesia following Traumatic Brain Injury: A Systematic Review

et al. 2022

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Agitation is common in the early recovery period following traumatic brain injury (TBI), known as post-traumatic amnesia (PTA). Non-pharmacological interventions are frequently used to manage agitation, yet their efficacy is largely unknown. This systematic review aims to synthesize current evidence on the effectiveness of non-pharmacological interventions for agitation during PTA in adults with TBI. Key databases searched included MEDLINE Ovid SP interface, PubMed, CINAHL, Excerpta Medica Database, PsycINFO and CENTRAL, with additional online reviewing of key journals and clinical trial registries to identify published or unpublished studies up to May 2020. Eligible studies included participants aged 16 years and older, showing agitated behaviours during PTA. Any non-pharmacological interventions for reducing agitation were considered, with any comparator accepted. Eligible studies were critically appraised for methodological quality using Joanna Briggs Institute Critical Appraisal Instruments and findings were reported in narrative form. Twelve studies were included in the review: two randomized cross-over trials, three quasi-experimental studies, four cases series and three case reports. Non-pharmacological interventions were music therapy, behavioural strategies and environmental modifications, physical restraints and electroconvulsive therapy. Key methodological concerns included absence of a control group, a lack of formalised agitation measurement and inconsistent concomitant use of pharmacology. Interventions involving music therapy had the highest level of evidence, although study quality was generally low to moderate. Further research is needed to evaluate non-pharmacological interventions for reducing agitation during PTA after TBI.Systematic review registration number: PROSPERO (CRD42020186802), registered May 2020.

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“…Complexity of behaviour change following ABI is often compounded by the high prevalence of comorbid mental health issues (Simpson, Sabaz, Daher, Gordon & Strettles, 2014). These behaviour changes can interfere with a person’s ability to live independently in the community, to work or study, or have relationships with other people (Gould et al, 2021; Hicks et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…There are no evidence-based guidelines for managing behaviours of concern after ABI; however, various approaches to the management of behaviours of concern have been described in the literature (Alderman et al, 2013; Gould et al, 2021; Rahman, Alderman & Oliver, 2013). Positive behavioural support (PBS) is an intervention model that emerged in the mid 1980’s as a broad approach to managing behaviours of concern in people with developmental and intellectual disabilities with a focus on quality of life outcomes (Brown, Michaels, Oliva & Woolf, 2008; Hayward, Poed, McKay-Brown & McVilly, 2021).…”

Section: Introductionmentioning

confidence: 99%

Behaviour support for people with acquired brain injury within the National Disability Insurance Scheme: an Australian survey of the provider market

2022

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Background and objectives: People with acquired brain injury (ABI) may experience behaviours of concern that require therapy services, including behaviour support. In Australia, the implementation of a National Disability Insurance Scheme (NDIS) and development of the NDIS Quality and Safeguards Commission, has led to significant changes to behaviour support workforce processes, and the way behaviour support is funded, regulated and delivered to people with ABI who are Scheme participants. The aim of this study was to explore the current and future provider market of professionals providing behaviour supports to Scheme participants who experience ABI. Method: An anonymous survey was designed and distributed via social media channels, an email listserv and professional association newsletters to professionals working within the NDIS in Australia. Data were analysed using descriptive statistics and content analysis. Results: One hundred and two surveys responses were analysed. A majority of professionals had an average understanding of the NDIS Quality and Safeguard Commission rules and policies on behaviour support. Responses to current and future registration as an NDIS Practitioner indicated the workforce gap could increase by between 17 and 26%. Respondents also raised concerns about the lack of training and experience of allied health professional students and graduates in addressing behaviours of concern. Responses to the open-ended question highlighted additional issues in the provision of behaviour support within the NDIS. Conclusions: This research highlighted the need for an NDIS behaviour support workforce strategy and supply-side market intervention to ensure a viable and sustainable workforce for people with ABI who need behaviour support.

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Positive behaviour support for challenging behaviour after acquired brain injury: An introduction to PBS + PLUS and three case studies

Cited by 23 publications

References 47 publications

Neuro‐behavioural changes after acquired brain injury: The role of the occupational therapist; the interventions they use and why

Neuro‐behavioural changes after acquired brain injury: The role of the occupational therapist; the interventions they use and why

Effectiveness of Non-Pharmacological Interventions for Agitation during Post-Traumatic Amnesia following Traumatic Brain Injury: A Systematic Review

Behaviour support for people with acquired brain injury within the National Disability Insurance Scheme: an Australian survey of the provider market

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