Naturalistic physiological monitoring as an objective approach for detecting behavioral dysregulation after traumatic brain injury: A pilot study

BACKGROUND: Traumatic brain injury (TBI) often results in chronic behavior challenges that negatively impacts daily functioning and independence. OBJECTIVE: To test the potential for naturalistic physiological monitoring to detect behavioral dysregulation in adults with chronic TBI. METHODS: Fourteen individuals with medically documented TBI currently receiving services at a comprehensive brain injury rehabilitation program completed a series of challenging problem-solving tasks while wearing physiological monitoring technology. The behavioral dysregulation rating scale was then used for measuring behavioral events and comparison with physiological data collected during task completion. RESULTS: The problem-solving tasks proved to be candidates for eliciting behaviors of dysregulation. Clinically meaningful change was observed for both heart rate and heart rate between baseline and the task period. Although between-subject aggregates of physiology moved in expected directions, intra-individual change was highly varied— suggesting the importance of within-subject change when assessing the utility of physiology when attempting to detect behavioral change naturalistically. CONCLUSIONS: This study provides preliminary evidence for a TBI-specific ecological momentary assessment platform measuring behavior and provides preliminary support for the use of wearable physiological monitoring technology for detection of behavioral dysregulation events after TBI. Further examination of heart rate and heart rate variability as signals for behavior is encouraged.