P
Priority
F
Fundamental

New
Level of evidence
A
B
C
R 1.1
P
C
During the subacute phase of traumatic brain injury, if the neurobehavioural status of the individual is deteriorating or not progressing as expected, an assessment by a licensed specialist should be made to differentiate neurobehavioural difficulties from symptoms of a comorbid illness or medication side effects.
(Adapted from INCOG 2014, Assess 7, p. 298)
Note: Comorbid illness may include seizures, mood and anxiety disorders, personality disorders, metabolic disorders, medication side effects, attention issues, hearing impairment, communication impairment and substance abuse.
R 1.2
P
C
In general, an assessment of neurobehavioural issues following traumatic brain injury must address pre-injury vulnerability factors, injury-related factors and postinjury factors.
(Adapted from INCOG 2014, Assess 6, p.297)
Note:
Pre-injury vulnerability factors include:
Prior medical/neurological conditions, mental health disorders, substance use disorders, temperamental/personality factors, cognitive/intellectual ability, academic/vocational function, psychosocial circumstances
Injury-related factors include:
Nature of injury (i.e., severity, focal vs. diffuse), cerebral involvement, anatomic injury location, extent of secondary injury, co-occurring extracranial injury
Post-injury factors include:
Psychological response / coping style, cognitive status, social/economic changes, new-onset mental health disorders, medical conditions (such as seizures, sensorimotor changes, endocrine dysfunction, pain, sleep/wake disturbance), medication effects
R 1.3
C
Clinicians should carefully define and characterize the presenting neurobehavioural issue through a combination of diagnostic interviews (including close relatives and the health care team) and direct observation of the person with traumatic brain injury.
(INESSS-ONF, 2015)
R 1.4
P
B
Any behavioural management plan for individuals with traumatic brain injury must include a consideration of the precipitating factors or triggers possibly leading to the behaviour and reinforcing events.
(Adapted from ABIKUS 2007, G24, p. 20)
R 1.5
P
C
Individuals who have sustained a traumatic brain injury after a known or suspected incident of self-harm or a suicide attempt should have a risk assessment performed and should be referred as appropriate.
(Adapted from NZGG 2006, 3.11, p. 66)