Aggressive behaviour observed within a neurobehavioural rehabilitation service: utility of the OAS-MNR in clinical audit and applied research

Abstract

The Overt Aggression Scale-Modified for Neurorehabilitation (OAS-MNR) has been proposed as a means of standardizing descriptions of post-acute aggressive behaviour disorders amongst people with acquired brain injury. Single cases in the literature have illustrated its clinical utility. In this paper, its contribution to clinical audit and applied research is explored. The scale was used to record all aggressive behaviour exhibited by 46 patients participating in a neurobehavioural programme during a 14 day period. Data for 3914 acts of aggression were captured. Whilst most was verbal, 443 comprised physical assaults on others. Results suggest the OAS-MNR can be usefully employed to audit practice, and has a role to play in resource allocation: however, efficacy remains best judged at the single case level. Regarding clinical research, it was found that patients with low language function were more likely to physically assault others in the absence of identifiable antecedents. Furthermore, this was more severe and required more intrusive interventions to manage it than aggression shown by the same patients which had identifiable antecedents, or any aggression exhibited by patients whose language was better preserved. It is argued that poor language function creates significant barriers to the treatment of aggression, and, whilst intervention methods with good outcome have previously been described, these are no longer routinely available in the UK. An appeal to reverse this is made.