Acquired Brain Injury Clinical Trial
Official title:
A Biofeedback Intervention for the Prevention of Challenging Behaviour in People With Acquired Brain Injury
This study aims to explore whether feedback from a physical monitoring device (electronic watch) to prompt patients to use an anxiety management strategy can help prevent challenging behaviour.
A multiple baseline "A-B-A" single case experimental design will be adopted with baseline,
intervention, and return to baseline phases.
Participants will wear the portable monitoring device with heart rate monitor, pedometer and
global positioning system (GPS) functions. A pre-calculated algorithm, developed using
machine learning software will be used to predict challenging behaviour episodes 2-4 hours in
advance of the event. Recent research has developed a best predictor model with a sensitivity
of 82% and specificity of 42%, when averaged across two participants (in press). The device
will communicate with a smart phone, via Bluetooth connectivity, when an event has been
predicted.
Following enrolment in the study, participants will be randomly assigned to a treatment start
time, which will follow from an initial baseline phase. During the baseline phase,
participants will wear a commercially available smart watch with physiological monitoring
capability, for at least one month in order to gather behaviour frequency data, and
associated physiological data; no prompts will be provided. During this period, behavioural
and physiological data will be sent to a secure server where a machine learning algorithm
will examine the relationships between data streams and 'self-tune' to improve its prediction
of challenging behaviour episodes. In the treatment phase, participants and staff will
receive a biofeedback prompt in text, or graphic form (e.g. mood light), on the smart
watch/connected mobile phone, when an event has been predicted. This will prompt participants
to implement a proactive anxiety management strategy, and will prompt staff to support the
participant in completing this, if required. The strategy used will be predetermined in the
participant's standard care plan e.g. breathing relaxation, reframing the problem,
behavioural redirection. Details will be recorded using an adapted version of the Overt
Aggression Scale-Modified for Neurorehabilitation (OAS-MNR), describing the situation in
which the biofeedback prompt occurred, participant and staff responses to the biofeedback
prompt, and any resulting behaviours, including the occurrence of challenging behaviour.
Following the intervention phase, participants will return to a baseline phase for one month,
in which no prompts will be provided. Again, details of any challenging behaviour will be
recorded via the OAS-MNR.
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