Reduction of severe aggressive behaviour in acquired brain injury: case studies illustrating clinical use of the OAS-MNR in the management of challenging behaviours

Challenging behaviour, especially when this takes the form of aggression, m ay impede or prevent progress in neurorehabilitation. Despite its prevalenc e, the literature on management of aggression after brain injury is not ext ensive. It has been suggested that the 'Overt Aggression Scale-Modified for Neurorehabilitation' (OAS-MNR) could be used to help standardize future st udies of aggressive behaviour. It was also suggested that this scale has su fficient properties to be useful in clinical work. In this paper, three cas e studies are described which attempt to illustrate the potential value of the OAS-MNR in neurorehabilitation. The use of the scale also provides evid ence relating to the continued efficacy of the neurobehavioural model. In t he first study, two cases are described in which reduction in aggression oc curred through participation in individualized, needs-led holistic treatmen t programmes, which incorporated multiple interventions. These were based o n neurobehavioural principles. In the second study, a further single case w as presented which illustrated how the scale may be used to generate hypoth eses regarding aggressive behaviour and to drive treatment. Causation and m aintenance of aggression are discussed, especially with regard to cognitive impairment. Finally, practical points relating to the use of the OAS-MNR i n clinical practice are reviewed.