Association for Behavior Analysis International

Applied Behavior Analysis (ABA) has increasingly gained recognition for its utility in Traumatic Brain Injury (TBI) rehabilitation. Residential treatment programs specializing in brain injury rehabilitation have only recently began to emphasize behavior analytic principles as a foundational approach to multidisciplinary rehabilitation. While ABA is the focus of treatment for Autism and other developmental disabilities, TBI is viewed as a disease process that responds to a combination of medical care and rehab modalities. Given ABA's growing presence in the field of TBI rehabilitation, it is imperative that ABA professionals work as part of a multidisciplinary team and be versed in the languages of other disciplines. By gaining familiarity with the language of rehabilitation, behavior analysts will be better suited to facilitate use of ABA within the integrated rehabilitation framework and perhaps take a greater role in coordinating care. This symposium will define terminology used to refer to a common constellation of behaviors post-TBI and identify the value of coordinated care by behavior analysis within a multidisciplinary rehabilitation system. A discussion of these content areas will also be provided, which will emphasize the value of integrating the theory of ABA into TBI culture.

Traumatic Brain Injury (TBI) is a public health concern impacting approximately 1.7 million people annually and a contributing factor to nearly 1/3 of all injury-related deaths in the United States. TBI results in not only physical impairment, but also disrupts planning, verbal behavior, problem solving, attention, recall, and other types of behavior often labeled "executive functioning." These types of non-motoric problems have been labeled the "essence of brain injury." As such, executive functioning is a multifaceted construct that draws upon a set of diverse, private problem solving behaviors and overt behavior sequences required for effective levels of independent, goal-directed behavior, particularly activities of daily living and skills needed to return to work/school. Such general and metaphorical terminology can be a barrier to effective participation by behavior analysts in this area. Thus, this presentation will define behavioral and functional characteristics of post-TBI executive dysfunction, and review the current Applied Behavior Analysis-based rehabilitation approaches available to remediate executive dysfunction as it pertains to community reintegration.

Comprehensive rehabilitation for traumatic brain injury (TBI) involves a multidisciplinary approach that can include ABA as well as other services- occupational therapy, physical therapy, speech-language pathology, psychiatry, physiatry, residential support and medical care. When providing ABA services to the TBI population, coordination of these other services can lead to better long-term outcomes. While the responsibility of case management typically falls on Social Work, the ABA provider may need to follow-up with service coordination needs in order to provide the most effective treatment in the shortest time frame. In settings where insurance funding is limited, the ABA provider may be the only professional providing service to the TBI survivor. Case study examples from a post-acute Adult TBI Program in the Midwest will illustrate how coordinating Case Management and ABA activities have improved treatment outcomes for TBI survivors. Strategies for complementing ABA services with physiatry, psychopharmacology and residential support will be explored.