Author Affiliations: Parkwood Institute Research, Lawson Research Institute London, Ontario, (Drs MacKenzie, Teasell, and Mehta); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario (Drs MacKenzie, Teasell, and Mehta); Department of Physical Medicine and Rehabilitation, Parkwood Institute, St. Joseph's Health Care London, London, Ontario (Drs MacKenzie and Teasell) Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Ontario, and Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario (Dr Velikonja); Schulich School of Medicine and Dentistry, Western University, London, Ontario (Mss J. Devito and L. Devito); Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario (Ms Patsakos); KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario (Ms Patsakos and Dr Bayley); and Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario and University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario (Bayley).
J Head Trauma Rehabil. 2024;39(5):382-394. doi: 10.1097/HTR.0000000000000973. Epub 2024 Sep 10.
Behavioral changes following moderate to severe traumatic brain injury (MSTBI) are common and can include agitation or aggression, reduced arousal or apathy, and inappropriate sexual behavior. These changes can negatively affect recovery, function, and quality of life. Pharmacological and nonpharmacological interventions are often used to address these challenges; however, there is limited evidence regarding the effectiveness of these treatments. This article will summarize the updated recommendations for the assessment and management of behavioral changes in adults after MSTBI.
A systematic search was conducted by the evidence-based review of moderate to severe acquired brain injury to identify new and relevant articles. Expert panels reviewed and discussed the new and existing evidence, evaluated its quality, and added, removed, or modified recommendations and tools as needed. A consensus process was followed to achieve agreement on recommendations.
The 2023 Canadian Clinical Practice Guideline for the Rehabilitation of Adults with Moderate to Severe Traumatic Brain Injury (CAN-TBI 2023) includes 21 recommendations regarding best practices for the assessment and management of behavioral disorders post-MSTBI. Fifteen recommendations remained unchanged, and 6 recommendations were updated. Eight recommendations are based on level B evidence and 13 on level C evidence. There are no recommendations based on level A evidence. The guideline also includes a step-by-step algorithm for clinicians to follow outlining an approach to the assessment and management of agitation and aggression.
CAN-TBI 2023 will assist clinicians in the assessment and safe and effective management of behavioral changes post-MSTBI. The guideline is informed by a growing scientific database although there is a need for additional high-quality research to better guide the assessment and management of this complex patient population.
中度至重度创伤性脑损伤（MSTBI）后常见行为改变，包括激越或攻击行为、觉醒或淡漠减少以及不当性行为。这些变化会对康复、功能和生活质量产生负面影响。常采用药物和非药物干预来解决这些挑战；然而，这些治疗方法的有效性证据有限。本文将总结 MSTBI 成人行为改变评估和管理的最新建议。
通过对中度至重度获得性脑损伤的循证综述进行系统搜索，以确定新的和相关文章。专家小组审查和讨论了新的和现有的证据，评估其质量，并根据需要添加、删除或修改建议和工具。采用共识过程达成对建议的一致意见。
2023 年加拿大中度至重度创伤性脑损伤康复临床实践指南（CAN-TBI 2023）包括 21 条关于 MSTBI 后行为障碍评估和管理最佳实践的建议。15 条建议保持不变，6 条建议进行了更新。8 条建议基于 B 级证据，13 条建议基于 C 级证据。没有基于 A 级证据的建议。该指南还包括一个供临床医生遵循的逐步算法，概述了评估和管理激越和攻击行为的方法。
CAN-TBI 2023 将帮助临床医生评估和安全有效地管理 MSTBI 后的行为变化。该指南基于不断增长的科学数据库，但需要更多高质量的研究来更好地指导这一复杂患者群体的评估和管理。
