A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma)

Background Paroxysmal sympathetic hyperactivity, which affects up to 10% of all acquired brain injury survivors, is characterized by elevated heart rate, blood pressure, respiratory rate, and temperature; diaphoresis; and increased posturing. Pharmacological agents that have been studied in the management of this disorder include opiates, γ-aminobutyric acid agents, dopaminergic agents, and β blockers. Although paroxysmal sympathetic hyperactivity is a relatively common complication after acquired brain injury, there is a paucity of recommendations or comparisons of agents for the management of this disorder. Objective To evaluate all relevant literature on pharmacological therapies used to manage patients with paroxysmal sympathetic hyperactivity to help elucidate possible best practices. Methods Of the 27 studies evaluated for inclusion, 10 studies received full review: 4 retrospective cohort studies, 5 single case studies, and 1 case series. Results Monotherapy is usually not effective in the management of paroxysmal sympathetic hyperactivity and multiple agents with different mechanisms of action should be considered. α2-Agonists such as dexmedetomidine may hold some slight clinical efficacy over agents like propofol, and with respect to oral medications, propranolol might convey some slight advantage compared to others. However, with the limited data available, these results must be interpreted with caution. Conclusions As the treatment of paroxysmal sympathetic hyperactivity is reactive to symptomatic evolution over time, critical care nurses play a vital role in the monitoring and treatment of these patients. Limited data exist on the management of paroxysmal sympathetic hyperactivity and larger robust data sets are needed to guide decision-making. (Critical Care Nurse. 2020;40[3]:e9-e16)

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A Systematic Review of Acceptance and Commitment Therapy (ACT) for Managing Anxiety: Applicability for People With Acquired Brain Injury?

Brain Impairment ◽

10.1375/brim.12.1.54 ◽

2011 ◽

Vol 12 (1) ◽

pp. 54-70 ◽

Cited By ~ 16

Author(s):

Cheryl Soo ◽

Robyn L. Tate ◽

Amanda Lane-Brown

Keyword(s):

Brain Injury ◽

Acceptance And Commitment Therapy ◽

Methodological Quality ◽

Single Case ◽

Controlled Trial ◽

Acquired Brain Injury ◽

Emotional States ◽

Compulsive Disorder ◽

Commitment Therapy ◽

Acceptance And Commitment

AbstractAcceptance and commitment therapy (ACT) is increasingly used in clinical practice to manage anxiety conditions. This psychotherapeutic approach focuses on the following: (1) acceptance of an individual's experience of the spectrum of psychological and emotional states, (2) choosing valued direction for the individual's life, and (3) commitment to action that leads the individual in the direction of those values. This article presents an empirical review of ACT for treatment of anxiety in two parts. In the first part we systematically review the literature for studies examining ACT for anxiety management in the general population with anxiety problems. In the second part, we discuss applicability of acceptance-based approaches for a health population in which these techniques may have applicability, that is, for people with acquired brain injury (ABI). Electronic searches for the review were conducted on PsycINFO and Medline. Inclusion criteria were as follows: (1) used an ACT intervention study, (2) the target of the intervention was an anxiety disorder or anxiety symptomatology, (3) the intervention used a randomised controlled trial (RCT) or single case experimental design (SCED) methodology, and (4) the paper was available in English. Studies were rated for methodological quality using standardised assessment procedures. Four RCTs provided support for ACT for obsessive compulsive disorder (OCD), maths anxiety, trichotillomania (TTM), and mixed anxiety and depression. Three SCED trials scoring in the high range on the scale of methodological quality revealed some support for ACT for managing TTM, skin picking, and OCD. Although no studies were identified that investigated ACT for managing anxiety in people with ABI, the review highlights issues for consideration when applying ACT in this population.

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Brief functional analysis of repetitive verbal behavior (vocal stereotypy) for an adult with acquired brain injury

International Journal on Disability and Human Development ◽

10.1515/ijdhd-2014-0021 ◽

2016 ◽

Vol 15 (1) ◽

Author(s):

Craig Strohmeier ◽

Sorah Stein ◽

Ennio Cipani

Keyword(s):

Functional Analysis ◽

Brain Injury ◽

Environmental Factors ◽

Verbal Behavior ◽

Single Case ◽

Acquired Brain Injury ◽

Design Data ◽

Vocal Stereotypy ◽

Functional Relations ◽

Outpatient Program

AbstractThe behavior analytic method of functional analysis (FA) is a process for identifying behavior-environment functional relations. Some research indicates the use of FA procedures to determine the environmental factors that maintain odd or inappropriate verbal behavior. The current study demonstrates the use of an FA to identify environmental influences on repetitive verbal behavior for an adult with acquired brain injury (ABI).A brief FA of repetitive verbal behavior was conducted in an outpatient program for individuals with ABI. Four conditions were alternated in a multielement single-case experimental design. Data were collected across conditions to determine if specific contextual variables differentially influenced the occurrence of repetitive verbal behavior.Data revealed increased occurrences of repetitive verbal behavior in a test condition that included contingent attention.Specific environmental factors were identified as sources of control for repetitive verbal behavior. The results of this case report support the use of FA for repetitive verbal behavior exhibited by individuals with ABI.

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