Article

Behavioural changes are the main cause of difficulties in interpersonal
relationships and social integration among traumatic brain injury (TBI) patients.
The Societe francaise de medecine physique et readaptation (SOFMER) decided to
develop recommendations for the treatment and care provision for these problem
under the auspices of the French health authority, the Haute Autorite de la sante
(HAS). Assessment of behaviour is essential to describe, understand and define
situations, assess any change and suggest lines for intervention. The
relationship of these behavioural changes with the brain lesion is likewise of
crucial importance in legal and forensic expertise. AIMS: Using a literature
review and expert opinions, the aim was to define the optimal conditions for the
collection of data on behavioural changes in individuals having sustained brain
trauma, to identify the situations in which they arise, to review the instruments
available, and to suggest lines of intervention.
METHODS: A literature search
identified 981 articles, among which 122 on the target subject were selected and
analysed in detail and confronted with the experience of professionals and user
representatives. A first draft of the recommendations was produced by the working
group, and then submitted to a review group for opinions and complements.
RESULTS: The literature on this subject is heterogeneous, and presents low levels
of evidence. No article enabled the development of recommendations above the
"expert opinion" level. After prior clarification of the aims of the evaluation,
it is recommended first to carefully describe the changes in behaviour, from
patient and third-person narratives, and where possible from direct observations.
The information enabling the description of the phenomena occurring should be
collected by different individuals (multi-source evaluation): the patient, his or
her close circle, and professionals with different training backgrounds
(multidisciplinary evaluation). The analysis of triggering or associated factors
requires an assessment of cognitive functions and any neurological pathology
(seizures). After confrontation and synthesis, the information should be
completed using one or several behavioural scales, which provide objectivity and
reproducibility. The main generic and specific scales are presented, with their
advantages, drawbacks and validation references. The group did not wish to
recommend any one of them in particular. CONCLUSION: The evaluation of
behavioural changes is essential, since without it a therapeutic strategy and
appropriate orientation cannot be implemented. The emphasis should be put on
contextualised, multi-source and multidisciplinary evaluation, including
validated behavioural scales. In this area, nevertheless, evaluation is still
restricted by several methodological limitations. Further research is needed to
improve the standardisation of data collection and the psychometric properties of
the instruments. A European harmonisation of these procedures is also greatly
needed.
CI - Copyright (c) 2015 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS