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| Applications of Applied Behavior Analysis in Post-Acute Brain Injury Rehabilitation |
| Sunday, May 24, 2009 |
| 9:00 AM–10:20 AM |
| North 222 C |
| Area: CBM; Domain: Applied Behavior Analysis |
| Chair: Chris Persel (Centre for Neuro Skills) |
| Abstract: The Centre for Neuro Skills (CNS) is a three-site post-acute inpatient rehabilitation program for individuals with acquired brain injuries. Founded in 1980, CNS provides comprehensive therapy, community reintegration and integrated behavioral programming for this complex population. In order to provide the highest quality behavioral care possible for clients, obtaining data to assist with making clinical decisions is imperative. The first study addresses challenges surrounding the consistency of staff data collection and focuses on improving the frequency of staff data collection behaviors. The following three studies review unique clinical applications of applied behavior analysis interventions for challenging behaviors of individuals with acquired brain injuries within a CNS program. The focus of these studies is on therapy-staff implemented ABA interventions that were shown successful at improving behaviors of adolescent and adult clients. Generalization, maintenance, and effects of the interventions are addressed. |
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| Want to win the lottery? Using a lottery to improve staff data collection |
| JESSICA THOMPSON (Centre for Neuro Skills), Heather A. Moore (Centre for Neuro Skills), Chris Persel (Centre for Neuro Skills) |
| Abstract: Inconsistent data collection by staff members can lead to difficulties in making accurate, effective, and beneficial decisions regarding the behavior of clients. This study investigated the use of a lottery system implemented to increase the data collection behaviors of staff at two large multidisciplinary traumatic brain injury rehabilitation clinics. Raffle cards were distributed to clinic staff members observed spontaneously and independently engaging in data collection related behaviors. One weekly winner was drawn from the previous week’s cards at a weekly meeting of all clinic staff. Monthly “bonus” drawings were also conducted the last week of each month in which all cards for the month were included and both the staff who was observed and the staff who delivered the card were able to choose a prize. Winning staff for all drawings could choose from a variety of 4 randomly available prizes. The prizes available varied from week to week. Changes in data collection behaviors following implementation of the staff lottery were experimentally assessed using a multiple-baseline across sites design. Results showed that the staff lottery was effective at increasing data collection as the average percentage of data collected prior to the lottery was 26% as compared to 65% following lottery implementation. Maintenance of these results was demonstrated. Findings suggest that lotteries may be a cost effective and time efficient method of increasing specific desired staff behaviors. |
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| Effective use of social positive reinforcement in decreasing maladaptive behaviors of a young adult with significantly impaired short-term memory due to an acquired brain |
| HEATHER A. MOORE (Centre for Neuro Skills), Chris Persel (Centre for Neuro Skills) |
| Abstract: This study evaluated the use of social positive reinforcement with a client with impaired short-term memory as a result of an acquired brain injury. The participant was a 19-year-old male client in a post-acute brain injury rehabilitation program who engaged in maladaptive behaviors including elopement, motor and verbal perseverations, and attempts to obtain food regardless of circumstances. A comprehensive treatment plan was designed. This treatment plan was implemented and used a picture chart that had multiple pieces that were provided contingent on appropriate behavior. He was then provided food contingent on successfully earning all the pieces to complete the picture. The data collected suggest that implementation of this program produced pronounced reductions in all maladaptive behaviors. Dramatic increases in appropriate behaviors in both the rehabilitative therapy and community environment were also observed. Maintenance of the new behaviors was demonstrated. Clinical implications for treatment and implications for future research are discussed. |
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| Effective use of a token system in decreasing physical aggression and self-injurious behavior in an adolescent with an acquired brain injury |
| HEATHER A. MOORE (Centre for Neuro Skills), Chris Persel (Centre for Neuro Skills) |
| Abstract: Following traumatic brain injury individuals often engage in severe physically aggressive behaviors. In an attempt to maximize the possible benefits of their therapy, it’s important to decrease interfering maladaptive behaviors. This study investigated the use of a token system with a 13- year-old male client in an inpatient post-acute brain injury rehabilitation program. The treatment plan implemented utilized a DRO 15-minute program in which points were earned contingent on the absence of physical aggression and self-injury. The points were later redeemable for snacks at pre-determined snack times. The data collected suggest that implementation of this program produced dramatic reductions in the maladaptive behaviors and the need for physical restraint. Generalization to other settings and maintenance of the skills was demonstrated. |
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| Use of a self-monitoring procedure to improve social behaviors of an adult with an acquired brain injury |
| CHRIS PERSEL (Centre for Neuro Skills), Jessica Thompson (Centre for Neuro Skills), Heather A. Moore (Centre for Neuro Skills) |
| Abstract: Social difficulties have been noted as a common behavior problem exhibited by individuals recovering from traumatic brain injury. The lack of ability to self-monitor interactions can interfere with personal relationships, vocational pursuits and community reintegration. This study investigated a structured self-monitoring program to aide in the reduction of inappropriate social behavior of a 48-year-old traumatically injured adult male. Inappropriate social behaviors displayed included excessive talking, perseveration on topics, interrupting others and exaggerated recall of facts. While the self-monitoring program was originally designed to be a clinical application used to help this client, findings from the investigation have potential implications for future research and client treatment. The two-phase self-monitoring program implemented initially included self-monitoring followed by delayed feedback during counseling sessions. Problem behavior was unchanged. Modifications were made including immediate constructive and positive feedback each hour. Inappropriate social behavior decreased and cooperation in therapy improved. Generalization, maintenance and implications for treatment and future research are discussed. |
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