Level of evidence
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.
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)
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
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.
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)
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)