Research Reports - Predictors of agitated behavior during inpatient rehabilitation for traumatic brain injury

Arch Phys Med Rehabil. 2015 Aug;96(8 Suppl):S274-S281.e4. doi:
10.1016/j.apmr.2015.04.020.

Bogner J(1), Barrett RS(2), Hammond FM(3), Horn SD(2), Corrigan JD(4), Rosenthal
J(4), Beaulieu CL(5), Waszkiewicz M(6), Shea T(4), Reddin CJ(7), Cullen N(8),
Giuffrida CG(6), Young J(6), Garmoe W(9).

OBJECTIVE: To identify predictors of the severity of agitated behavior during
inpatient traumatic brain injury (TBI) rehabilitation.
DESIGN: Prospective, longitudinal observational study.
SETTING: Inpatient rehabilitation centers.
PARTICIPANTS: Consecutive patients enrolled between 2008 and 2011, admitted for
inpatient rehabilitation after index TBI, who exhibited agitation during their
stay (n=555, N=2130).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURE: Daytime Agitated Behavior Scale scores.
RESULTS: Infection and lower FIM cognitive scores predicted more severe
agitation. The medication classes associated with more severe agitation included
sodium channel antagonist anticonvulsants, second-generation antipsychotics, and
gamma-aminobutyric acid-A anxiolytics/hypnotics. Medication classes associated
with less severe agitation included antiasthmatics, statins, and
norepinephrine-dopamine-5 hydroxytryptamine (serotonin) agonist stimulants.
CONCLUSIONS: Further support is provided for the importance of careful serial
monitoring of both agitation and cognition to provide early indicators of
possible beneficial or adverse effects of pharmacologic interventions used for
any purpose and for giving careful consideration to the effects of any
intervention on underlying cognition when attempting to control agitation.
Cognitive functioning was found to predict agitation, medications that have been
found in previous studies to enhance cognition were associated with less
agitation, and medications that can potentially suppress cognition were
associated with more agitation. There could be factors other than the
interventions that account for these relations. In addition, the study provides
support for treatment of underlying disorders as a possible first step in
management of agitation. Although the results of this study cannot be used to
draw causal inferences, the associations that were found can be used to generate
hypotheses about the most viable interventions that should be tested in future
controlled trials. 

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