The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint?

Abstract

Purpose: The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. New data on interventions used in the RNA and on how the RNA interventions can be used with patients with acquired brain injury (ABI) who have differing levels of functional impairment are provided in this paper.

Method: The study was conducted over a 6-week period in a secure 65-bed program for individuals with ABI that is housed in two units of a skilled nursing facility (SNF). Implementation of the RNA was compared between two units that housed patients with differing levels of functional impairment (n = 65 adults). Since this was a hierarchical clustered dataset, Generalized Estimating Equations regression was used in the analyses.

Results: RNA interventions used to manage the 495 aggressive incidents included the following: Aggression ignored, Closer observation, Talking to patient, Reassurance, Physical distraction, Isolation without seclusion, Immediate medication by mouth, Holding patient. Different interventions were implemented differentially by staff based on level of functional impairment and without use of seclusion or mechanical restraint.

Conclusions: The RNA can be used to non-aversively manage aggression in patients with brain injury and with differing levels of functional impairment. Programs adopting the RNA can potentially manage brain injury-related aggression without seclusion or mechanical restraint.

Implications for Rehabilitation

• The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression.

• RNA methods can be used to manage aggression in patients with brain injury who have differing levels of functional impairment.

• Successful implementation of the RNA may allow for the management of brain injury-related aggression without seclusion or mechanical restraint.

Keywords:

• Aggressive behaviors
• brain injury
• long-term care
• non-aversive
• relational neurobehavioral approach

Acknowledgements

The authors would like to thank the patients and staff of Crestwood Treatment Center in Fremont, California, Karen Scott, MOT, for research assistance, and Dr. David Manchester for comments on an earlier version of this manuscript.

Disclosure statement

The authors declare that there is no conflict of interest. The authors alone are responsible for the content and writing of this paper. Dr. Kalapatapu is currently funded by K23DA034883 (National Institute on Drug Abuse).