Actigraphy for assessment of sleep in traumatic brain injury: case series, review of the literature and proposed criteria for use.

Primary Objective: To demonstrate that actigraphy is an appropriate means of measuring sleep in patients with TBI and to define parameters for its use in this population.

Research Design: Case series and review of the literature.

Methods And Procedures: Subjects participating in one of two externally funded studies addressing the role of acupuncture in treating insomnia in TBI underwent actigraphy for the purpose of quantifying sleep time. Cases selected for presentation illustrate challenges in use of this modality in this population.

Main Outcomes And Results: Caution should be exercised in interpreting actigraphy data in patients with TBI and (1) motor impairment or (2) cognitive and behavioural impairments which include agitation and impulsivity.

Conclusions: Guidelines for use of actigraphy in patients with TBI are proposed: (1) Patients should be at Rancho Los Amigos cognitive level of III or above; (2) Patients with paresis, significant spasticity or contractures of one or more limbs should have the device placed on the least affected limb; and (3) For patients with tetraparesis, the device may not be an appropriate instrument for measurement of sleep; if it is to be used, consideration should be given to placing it on the head, rather than limbs or torso.