New Assessment Tool Validated for Challenging Behavior in ABI Rehabilitation

A recent study led by researchers at TIRR Memorial Hermann, and published in the PM&R Journal, a publication of the American Academy of Physical Medicine & Rehabilitation, provides strong evidence that the Overt Behavior Scale–In Session (OBS-INS) is a valid and reliable tool for systematically assessing challenging behaviors (CBs) following acquired brain injury (ABI) in the inpatient rehabilitation (IPR) setting.

Ranging from aggression and restlessness to elopement and disinhibition, CBs are among the most difficult brain-injury symptoms clinicians face when treating patients with ABI, particularly in the early stages of recovery. The OBS-INS was adapted from the original community-based Overt Behavior Scale through a collaboration between the team at TIRR Memorial Hermann and colleagues in Australia. The OBS-INS provides physicians and clinical teams with objective, reliable data to guide treatment decisions and improve interdisciplinary communication. For patients, this translates into better-informed care plans that promote and prioritize cognitive recovery.

“We had been looking for a behavioral rating tool that would capture the types of behaviors that are common in the early phases of recovery from a severe brain injury,” says author Lindsey Harik, PhD, clinical neuropsychologist and program manager for the Neurobehavioral Program at TIRR Memorial Hermann. “Existing scales either measured only one dimension of behavior, were designed for patients in the chronic phase or were too burdensome to complete regularly. We needed something that could objectively measure behavioral change in newly injured patients.”

The validation study included adults with traumatic brain injury, stroke and anoxic brain injury. OBS-INS scores correlated strongly with the Agitated Behavior Scale and moderately with the Disability Rating Scale. Reliability was excellent, and clinicians also endorsed the tool’s feasibility and utility for interdisciplinary communication, intervention planning and discharge readiness.¹

At TIRR Memorial Hermann, the OBS-INS is now embedded in the electronic health record and used routinely in the Neurobehavioral Program. The scale is administered after every therapy session, allowing clinicians to monitor changes in behavior across time and treatment modalities.

“This gives us a really robust way of understanding if the intensity, frequency or impact of a behavior has changed in response to treatment,” Dr. Harik explains. “Over time, we hope to build a large data set that will not only guide our interventions but also help us refine which strategies are most effective.”

Reference:

1. Herrin I, Harik L, Larkin E, et al. PM&R. 2025 Aug 19. doi.org/10.1002/pmrj.13448