|Traumatic Brain Injury and Behavior: Future Directions in Language Assessment, Field Research and Data
|Saturday, May 27, 2023
|4:00 PM–4:50 PM
|Hyatt Regency, Capitol Ballroom 5-7
|Area: CBM/BPN; Domain: Service Delivery
|Chair: Chris Persel (Centre for Neuro Skills)
|CE Instructor: Arielle Reindeau, M.S.
This symposium will address clinical challenges facing professional working in brain injury rehabilitation. This population offers unique dynamics that impact treatment and future program development. A functional-based language assessment tool to better identify the complex deficits and help treat important skills with the neurologically impaired will be presented. Developing guidelines for treating difficult behavior following brain injury could assist clinicians in effective implementation of rehabilitation.
|Instruction Level: Basic
|Keyword(s): brain injury, language assessment, neurocognitive disorder, rehabilitation
|Learning Objectives: 1. identify two clinical research strategies to improve internal validity in single case designs, increasing confidence in findings to aide in developing treatment guidelines in brain injury rehabilitation. 2. identify at least one refinement in the assessment of functional-based language difficulties following brain injury. 3. discuss one methodological and one environmental barrier to data collection on acute hospital, brain injury rehabilitation.
Clinical Research and Treatment Guidelines for Use in Brain Injury Rehabilitation: A Review of What We Have Learned
|CHRIS PERSEL (Centre for Neuro Skills), Cynthia Beaulieu (Ohio State University College of Medicine), Jennifer Bogner (Ohio State University College of Medicine), John Whyte (Moss Rehabilitation Research Institute), Tracy Shannon (Ohio State University College of Medicine), Daniel Hurlburt (Ohio State University College of Medicine), Natasha Huffine (Origami Brain Injury Rehabilitation Center)
This presentation will discuss evidence found on the effectiveness of behavior interventions with single-case experimental design methodology including behavior interventions that may display sufficient evidence to assist in the development of recommendations for management of behaviors in adults following moderate to severe TBI. Evaluation was completed on thirty-four studies that met inclusion criteria to review the effect of treatment interventions on defined target behaviors. Results will be presented on studies rated as having large, medium, small and no effect sizes. A trend was observed for lower internal validity scores in large and medium effect size studies. Randomization, blinded provider and assessor, and assessment of treatment adherence were the internal validity items consistently unlikely to be met. Single-case methodology was found to produce large and medium effect sizes for behavior interventions targeting difficulties in behavior regulation following moderate to severe brain injury. The strength of the evidence, however, was limited due to study designs that failed to meet internal validity criteria designed to reduce risk of bias when studying single subject interventions. Strategies will be outlined to improve the quality of study methodology and reduce the risk of bias, which may then provide better evidence to develop treatment guidelines for behavior interventions.
Piloting a Function-Based Language Assessment for Adults With Neurocognitive Disorder
|SAMANTHA HOUSTON (California State University, Sacramento), Dani Buckley (California State University, Sacramento), Megan R. Heinicke (California State University, Sacramento), Jonathan C. Baker (Western Michigan University), Shelby Marie Bryeans (California State University, Sacramento)
Language deficits are common following neurocognitive disorder (NCD), yet behavior analysts serving this growing population do not have a validated, function-based assessment to guide language programming. Gross, Fuqua, and Merritt (2013) developed and piloted the Verbal Behavior Assessment Battery (VBAB) to evaluate language deficits for older adults with dementia, but researchers have yet to replicate this study or evaluate this tool for adults following acquired brain injury (ABI). We expanded the VBAB to better capture the complex changes that may occur following ABI. We conducted the revised assessment with five adults with severe ABI and a matched control participant and found 1) varying deficits across ABI participants, 2) significant differences between the performance of ABI and control participants, 3) acceptable test-retest reliability, and 4) evidence for both functional independence and interdependence of verbal operants. Our discussion will focus on methodological considerations and potential refinement of the assessment for future clinical use.
|Changing Neurobehavioral Measurement Systems in an Acute Inpatient Brain Injury Rehabilitation Setting
|ARIELLE REINDEAU (Craig Hospital), Karen Fouts (Craig Hospital), Raevyn Goates (Craig Hospital), David White (Craig Hospital), Joshua Civic (Craig Hospital), Stephanie Agtarap (Craig Hospital), Emily Almeida (Craig Hospital)
|Abstract: Patients with moderate-to-severe acquired brain injury (ABI) often present with a multitude of behavioral changes, especially in the acute, inpatient hospital phase of rehabilitation. Inpatient rehabilitation staff such as nurses are asked to manage and measure behaviors that range from verbal threats to physical aggression alongside their daily routines. No gold standard currently exists to measure and monitor individualized behaviors within this unique setting. Utilizing a behavior analytic approach to measurement, we created an individualized data collection system to operationally define and track specific patient behaviors. This retrospective research study compared the utilization of the Agitated Behavior Scale (ABS) scale for patients with 1:1 supervision needs pre-program to the utilization of individualized scatterplots for patients with 1:1 supervision needs post-program. We found 1) a larger quantity of data collection related to behavior post-program 2) fewer instances of ‘no-data’ collected post-program and 3) significant differences between the percent of occurrence and non-occurrence of challenging behavior pre- to post-program. Our discussion will focus on methodological considerations and environmental barriers to measurement in acute, hospital-based neurorehabilitation settings.