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Updated Canadian Clinical Practice Guideline for the Rehabilitation of Adults With Moderate to Severe Traumatic Brain
Heather M MacKenzie1, Diana Velikonja, Julia Devito
1Author 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).
Objective:
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.
Design:
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.
Results:
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.
Conclusion:
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.
