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| Innovations in Neurorehabilitation: Applied Behavior Analysis In Traumatic Brain Injury |
| Sunday, May 30, 2004 |
| 9:00 AM–10:20 AM |
| Conference Room 3 |
| Area: CBM/EDC; Domain: Applied Research |
| Chair: Michael P. Mozzoni (Timber Ridge Group, Inc.) |
| Discussant: Terry J. Page (Bancroft NeuroHealth) |
| Abstract: Learning Objectives
Participants will learn about using a functional analysis in a mulitdisciplinary setting.
Participants will learn about therapeutic restraint as an emergency procedure and issues surrounding its use.
Participants will learn how to identify a stalled client and how to observe therapists training methods. |
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| The Effects of Fixed-Time Release from Restraint |
| GARY M. PACE (May Institute), James K. Luiselli (May Center for Education and Neurorehabilitation), Erin Dunn (May Institute) |
| Abstract: Reducing therapeutic restraint is a desirable outcome for programs that serve individuals that engage in dangerous behaviors. Impulsive behavior often associated with individuals with acquired brain injury increases the potential for unpredictable aggressive and destructive behavior. The present study investigated the effects of modifying the criterion for release from therapeutic restraint on the frequency and duration of restraint. Release from restraint was changed from contingent upon calm behavior to a fixed time in one child and two adolescents who displayed severe physical aggression and/or self injurious behavior. In all three students the duration of therapeutic restraint was reduced while the frequency remained unchanged. This resulted in substantial decreases in the time each student spent in restraints. Practical and ethical implications of these results and future research opportunities are discussed. |
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| Interdisciplinary Collaboration: Function-based Behavioral Treatment during Rehabilitation Therapy of Traumatic Brain Injury Patients |
| BRIDGET A. SHORE (Florida Institute for Neurologic Rehabilitation, Inc.), Claudia L. Dozier (Florida Institute for Neurologic Rehabilitation, Inc.), Shannon L. Root (Florida Institute for Neurologic Rehabilitation, Inc.), Daniel D. Knittel (Florida Institute for Neurologic Rehabilitation, Inc.) |
| Abstract: In an epidemiological analysis of self-injurious behavior, Iwata et al. (1994) found that several of their participants showed the highest rates of self-injurious behavior maintained by escape during idiosyncratic types of environmental stimuli such as ambient noise, social interaction, and physical examination. The purpose of this presentation is to demonstrate the efficacy of functional analysis to identify the maintaining variables for problem behavior during rehabilitation therapy for participants with traumatic brain injury, and subsequently prescribe the appropriate function-based treatment during therapy sessions. Three patients with traumatic brain injuries in an inpatient intensive rehabilitation program who displayed inappropriate behavior during speech, occupational, and/or physical therapy participated in the study. First, functional analyses were conducted and showed all three participants’ inappropriate behaviors (aggression, property destruction, verbal aggression) were maintained by escape from therapy instructions. Second, treatment consisting of FCT (escape), escape extinction, and reinforcement for compliance was implemented by the therapists, and results showed increased compliance and collateral gains in therapy goals for all three participants. Reliability data were collected for all three participants’ sessions and showed 80% or higher inter-observer agreement. These results suggest that collaboration between rehabilitation therapists and behavioral analysts can facilitate rehabilitation for patients with traumatic brain injury. |
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| Improving Outcomes in Brain Injury Rehabilitation: Case Managers' Decision Matrix |
| MICHAEL P. MOZZONI (Timber Ridge Group, Inc.) |
| Abstract: Length of treatment time in neurorehabilitation has steadily decreased while outcome expectations have increased. The purpose of this study was to replicate the utility of a decision matrix previously demonstrated by Mozzoni and Bailey (1996). In this study case managers (2) where instructed in the use of the decision matrix and the operational definitions of its items. Case managers identified stalled clients who were not on track to reach their projected outcome goal rating (Functional Assessment Measure) within the projected length of stay. They then utilized the decision matrix checklist to observe therapist teaching methods and gave suggestive feedback on areas they could change that were indicated on the 14-item checklist. Results demonstrate that diagnostic-based treatment intervention can result in obvious and measurable improvements in outcomes across patients. |
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