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| Behavior Analysis in Rehabilitation of Traumatic Brain Injury |
| Monday, May 26, 2008 |
| 10:30 AM–11:50 AM |
| Boulevard B |
| Area: CBM |
| Chair: Charles Gilpin (Missouri State University) |
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| Need for Behavioral Consultation and Training in Acute Rehabilitation Settings: Results of a Survey of Acute Brain Injury Facilities. |
| Domain: Applied Research |
| LISA ANN KREBER (Centre for Neuro Skills (CNS)) |
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| Abstract: Acute care brain injury facilities are faced with the challenges of medically stabilizing a patient who has suffered a catastrophic injury while at the same time managing severe behaviors. Often, there are staffing shortages and/or under trained staff dealing with brain injury survivors, especially those with behavioral self-control issues. Assessing how acute brain injury facilities manage severe behavior can assist other rehabilitation professionals in treating these clients once they have been discharged from acute to the post-acute rehabilitation setting.
A survey of acute brain injury rehabilitation facilities was administered to therapists, nurses, and other hospital staff to determine the techniques, training and challenges faced by acute care staff in dealing with behavior secondary to traumatic brain injury (TBI). The survey assessed three main areas which included identifying which activities are considered “behavior”, which techniques are useful/not useful in managing difficult behaviors, and what type of training was given for dealing with difficult behavioral situations. All responses were anonymous.
Preliminary results from this survey indicate that staffs do not feel they have enough training or experience to manage difficult behaviors following TBI. In fact, many of the techniques that were most often reported as useful in managing behavior involved the client’s family or the use of untrained sitters. However, many times these two groups are the most inexperienced in dealing with behavioral issues. Staffing shortages may also have triggered the use of family and sitters to control severe behaviors. It appears that therapists in the acute care setting want and need solutions for dealing with severe behaviors. The use of a behavioral analyst or consultant would be greatly beneficial in this type of rehabilitation setting. |
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| Integration of Behavioral Analysis within Traumatic Brain Injury Rehabilitation: Reduction of Psychoactive Medication and Cost-Benefit Experience. |
| Domain: Applied Research |
| CHRIS PERSEL (Centre for Neuro Skills (CNS)) |
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| Abstract: Rehabilitation of a person with TBI can be difficult considering the structures injured (often the frontal lobes) and the resulting impairments in judgment, behavioral self-control, and slowed information-processing ability. These deficits present challenges in applying behavioral analysis techniques to remediate many of the socially unacceptable behaviors that are often present following TBI. Medical models of treatment utilize pharmacological agents as the major, if not only, treatment for managing difficult behaviors. Medications used to treat behavior tend to have significant side effects and can be costly to continue long-term. Increased sedation and mental confusion are common side effects of “behavioral” medications, which can severely limit future behavioral change.
The goal of post-acute TBI rehabilitation is to re-integrate the injured person into their community. In order to achieve this, behavioral programming is integrated into each therapeutic discipline treating the client. Interval data sheets are used to collect data every 15 minutes in the clinic setting and each hour at the residential setting. Further frequency, intensity and duration data of target behaviors are collected and analyzed to create individual programs that are carried out across disciplines and the residential site. From this expansive amount of data, medication changes are made and evaluated in the context of target behaviors. Recreational/community activities and a measure of community integration (Independent Living Scale) are utilized to determine if skills learned in the traditional therapies have generalized into the “real” world.
This presentation will address how and why applied behavioral analysis techniques should be used in the post-acute rehabilitation setting following brain injury. Strategies used to reduce medications, while managing behavior will be discussed, as well as, cost-benefit analyses of medication reduction. |
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| Outcome Measurement: The Impact on Length of Stay and Goal Achievement in Neurobehavioral Rehabilitation. |
| Domain: Applied Research |
| MICHAEL P. MOZZONI (Learning Services Corporation) |
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| Abstract: The word “outcomes” has become a buzz word for the result of treatment. The myriad of definitions and measurement systems underscore the lack of consensus within functionally related groups (FRGs). Funding and accreditation organizations require outcome measurement yet hold no validity litmus test. The only requirement at this time is that the organization use the measures to provide feedback to the program. This study compares the length of stay (LOS) of persons with acquired brain injuries (ABI) in a program before and after the implementation of an outcome measurement system. |
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| Creating a Novel Measure of Everyday Problem Solving for Individuals with TBI Using Rasch Analysis. |
| Domain: Applied Research |
| JULIA KAY WAID-EBBS (Rehab Science, University of Florida/NF-SG Veterans Health System), Craig Velozo (Rehab Science, University of Florida/NF-SG VHS), Linda Shaw (Rehab Counseling/Phhp/University of Florida), Jay Rosenbek (Rehab Science, University of Florida/NF-SG Veterans Health System), Diane Kendall (Communication Sciences and Disorders/NF-SG Veterans Health System), Shelley Heaton (Clinical Psychology, University of Florida) |
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| Abstract: The present study developed a measurement tool of everyday problem solving abilities in individuals diagnosed with traumatic brain injury (TBI). Items of observable abilities were developed using focus groups, than administered to 50 outpatient and 50 one-year post injury subjects. Both the individual and their caregiver rated the problem solving abilities. The ratings were analyzed using a confirmatory factor analysis followed by a Rasch analysis. Historically problem solving abilities have been difficult to measure in the laboratory. Therefore, comparisons of the developed measure with traditional measures of problem solving are discussed. The developed measure will assist in identifying the everyday challenges that TBI patients face in the community. |
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