Association for Behavior Analysis International

Acquired brain injury rehabilitation is a practice area in great need of behavior analysts. According to the Centers for Disease Control and Prevention, the incidence of brain injury continues to increase, yet less than 1% of board certified behavior analysts report working in brain injury rehabilitation (Behavior Analyst Certification Board, n.d.). This symposium is intended to address this need and will feature three investigations from the experimental and applied realms of behavior analysis related to neurorehabilitation. In the first study, findings from a translational study on equivalence-based instruction via telehealth to re-teach name-face relations will be presented. The second evaluation will focus on staff turnover and accuracy of data collection in two residences for individuals with acquired brain injury. The final presentation will focus on the rapid changeover to telehealth rehabilitation services during the COVID-19 pandemic as well as refusal behavior with telehealth sessions. Discussion of the utility and implications of these evaluations will be presented as a demonstration of the effectiveness of behavior analysis for treatment of individuals with acquired brain injuries.

BCBAs

Deficits in name-face relations are common following an acquired brain injury and can increase secondary consequences of the injury such as depression. Within the behavior analytic literature, equivalence-based instruction has been successful in teaching stimulus-stimulus relations for various populations including individuals with differing disabilities. However, it has been nearly 30 years since researchers have evaluated an equivalence-based instruction procedure to address name-face deficits with brain injury survivors. This pilot study aimed to evaluate a revised stimulus equivalence protocol with five neurotypical college students to allow refinement of our procedural parameters prior to conducting a clinical evaluation with brain injury survivors. Our protocol included multiple exemplar training and errorless learning within a computerized simultaneous matching-to-sample procedure. All participants demonstrated equivalence among name-face relations, passed generalization probes, and maintained skills at a two-week follow-up without the need for remedial training. However, one participant required a few procedural modifications, and an error analysis as well as post-session survey results indicate that researchers should continue refining the parameters of equivalence-based instruction with college students before implementing the procedure with brain injury survivors. Additional modifications for both college students and acquired brain injury survivors are discussed.

Applying behavior reduction and skills reacquisition programming in neurorehabilitation settings is a unique challenge. Registered behavior technicians are extremely rare in neurorehabilitation, and board certified behavior analysts typically provide services on a consultation basis and are limited to a few hours per week per setting. Persons with acquired brain injury present with a kaleidoscope of challenges depending upon their trauma history, when they were injured, and their family support. High staff turnover rates adversely affect client outcomes and require continuous staff training and refreshment of skills. This investigation evaluated the quality of data collected by staff on behavior reduction vs. skill reacquisition programming and the effect of staff turnover on data collection.

Given the abruptness and uncertainty of the COVID-19 pandemic, many organizations pivoted to virtual service delivery. This presentation will briefly review the process of how telerehabilitation was implemented with behavioral patients at a post-acute brain injury rehabilitation facility over a period of nine months. In addition, attendees will be presented with case profiles, behavioral concerns and programming, and factors attributed to success and lessons learned (i.e., differences in function). Data, including participation and refusals with telehealth sessions, will be reviewed.