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Agitation has been defined as "an excess of one
or more behaviors that occurs during an altered state of consciousness
(Bogner & Corrigan, 1995). This definition is based on findings in
the research literature regarding traumatic brain injury and other conditions
which have agitation as a potential sequela. The definition emphasizes
the importance of "excessiveness" over the type of behavior
manifested. "Excessiveness" refers to the degree to which the
behavior interferes with functional activities and the extent to which
the behavior can be inhibited. No one type of behavior defines agitation,
though some component behaviors may be more dominant at times. The definition
also requires that the behavior occur during an altered state of consciousness
which, for traumatic brain injury, includes the diminished arousal present
from time of injury through the clearing of post-traumatic amnesia.
Because of its disruption of therapeutic goals, significant agitation during rehabilitation has to be addressed, and various behavioral, environmental and pharmacological interventions have been used. A survey conducted by Herbel, Schermerhorn and Howard (1990) found that facilities treating agitated patients use a variety of techniques, with most having options for one-to-one supervision, behavior modification, physical restraints, environmental modifications and medication. With regard to the latter, the research literature is sprinkled with case studies of the effectiveness of various medications in improving agitation. While there is not clinical consensus about which medications are effective in what circumstances (Fugate, Spacey, & Kresty, 1997), there is an understanding that those pharmacologic interventions which reduce agitation through sedation can delay, if not prevent, patients' cognitive and functional improvement during the acute phase of recovery (Mysiw & Sandel, 1997). Empirical support for this contention was provided by Corrigan and Mysiw (1988) who found that improvement in cognition was a prerequisite to improved agitation for patients who demonstrated both.