|Inpatient Brain Injury Rehabilitation: Need for a Behaviorally-Based Foundation
|Saturday, May 29, 2010
|2:30 PM–3:50 PM
|Domain: Applied Behavior Analysis
|Chair: Jessica A. Thompson (Centre for Neuro Skills)
|Discussant: Michael P. Mozzoni (Learning Services)
|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. Disruptive behavior, a common occurrence following TBI, has an impact on social reintegration and interferes with performance during the rehabilitation process, abilities, and functional skills. The first study addresses what impact the integration of behavioral principles into the interdisciplinary rehabilitation process has on a patient’s abilities, functional skills, and overall performance. This study compares groups of patients who demonstrated disruptive behaviors to peers who did not display disruptive behaviors and discusses outcomes, similarities, and differences among groups at program admission and discharge. The other two studies discuss use of differential reinforcement and escape extinction procedures to decrease problematic behaviors of two patients. These studies focus on therapy and residential-staff implemented programs that were shown effective at decreasing patient’s problem behaviors. Generalization, maintenance, and effects of the interventions are addressed
|Impact on Functional Skills and Abilities by Integrating Behavioral Principles Into Inpatient Clinical and Residential Rehabilitation Programs
|CHRIS PERSEL (Centre for Neuro Skills), Jessica A. Thompson (Centre for Neuro Skills), Heather A. Moore (Centre for Neuro Skills)
|Abstract: Disruptive behavior, a common occurrence following TBI, has an impact on social reintegration and interferes with performance, abilities, and functional skills. The objective of this study was to review the functional skills and abilities of those patients demonstrating problem behaviors as compared to those without significant disruptive behavior. Data from 147 adult patients with TBI who were admitted over a one-year period to an interdisciplinary inpatient rehabilitation program were analyzed. Patients were rated by assigned clinical and residential staff members upon admission and discharge on a scale designed to assess physical, language, and cognitive skills and scored on an objective living skills scale. Admission scores on a behavioral subscale determined which group patients were assigned to for retrospective analysis. Group 1 consisted of patients demonstrating disruptive behaviors including hitting, leaving therapy areas, or verbally refusing to participate. Group 2 consisted of patients demonstrating non-disruptive behaviors including active participation in therapy, following staff instructions, or appropriately communicating their needs. Groups 1 and 2 were indistinguishable on length of stay, time since injury, and gender. However, at admission Group 1 demonstrated significantly reduced functional skills and abilities. Both groups received treatment consisting of interdisciplinary therapies, combined with counseling and residential services. Behavioral principles including differential reinforcement and escape extinction were components of all programs. Ratings of abilities and functional skills at discharge were not significantly different between groups. Integration of behavioral principles in TBI rehabilitation may allow patients to demonstrate functional skills and abilities indistinguishable from behaviorally non-disruptive peers.
|Effective Use of Escape Extinction and Differential Reinforcement in Decreasing Physical Aggression in a Patient with a Traumatic Brain Injury
|HEATHER A. MOORE (Centre for Neuro Skills), Chris Persel (Centre for Neuro Skills)
|Abstract: The participant was a patient in a post-acute brain injury rehabilitation program who engaged in maladaptive behaviors which included biting, scratching, grabbing, and hitting rehabilitation staff members and herself. The treatment plan implemented across disciplines during therapy and at her residential setting included escape extinction following occurrences of physical aggression. Differential reinforcement was also used by providing breaks from therapy tasks following occurrences of appropriate behavior. Data collected suggests that implementation of this program produced significant reductions in maladaptive behaviors and increased the occurrences of appropriate behaviors. Appropriate behaviors were demonstrated and maintained in both rehabilitation therapy and in the community.
|Structured Escape Extinction and Differential Reinforcement During Inpatient Rehabilitation as an Approach to Improve Behaviors of an Adult With an Acquired Brain Injury
|CHRIS PERSEL (Centre for Neuro Skills), Heather A. Moore (Centre for Neuro Skills)
|Abstract: A structured escape extinction program was utilized with a 52 year-old traumatically brain injured adult female as part of a post-acute rehabilitation program. The program included escape extinction components, as well as differential reinforcement using music, swimming, snacks, and rest breaks following periods of demonstrated appropriate behavior. The effect of this program on reduction of severe problem behaviors including hitting, exiting therapy areas, running through the clinic hallways, cursing, and yelling loudly was investigated. Prior to intervention significant agitation was evident and she displayed behaviors categorized as emotionally labile, paranoid, psychotic, impulsive and combative. Data collection using a15-minute partial intervals format was initiated upon admission and was used to determine program effects. Prior to discharge, physically aggressive behaviors were eliminated and other problems behaviors were decreased in frequency. Medication was monitored and changes and possible effects will be discussed. Maintenance and generalization were evident following return home with her husband, as no significant behavioral difficulties occurred.