|Research and Application of Behavior Analytic Principles and Brain Injury|
|Sunday, May 27, 2018|
|8:00 AM–9:50 AM |
|Manchester Grand Hyatt, Seaport Ballroom B|
|Area: PRA; Domain: Applied Research|
|Chair: Chris M. Schaub (ReMed)|
|Discussant: Michael P. Mozzoni (Mozzoni Associates LLC)|
|CE Instructor: Chris M. Schaub, M.Ed.|
According to the Centers for Disease Control and Prevention an estimated 2.5 million people nationwide sustain a brain injury each year, with myriad implications and complications for the individual, their family and the rehabilitation community. As the incidence of brain injury is increasing so too is the need for effective assessment and treatment, as well as public awareness and education. This symposium will feature four presentations from the experimental and applied realms of behavior analysis intended to address these needs. In the first study, findings from a replication and extension of a previous inquiry into the functional independence of verbal operants will be presented. The second paper will describe function-based interventions for two individuals that reduced "exiting" behavior and increased participation, respectively. In the third paper a differential reinforcement procedure to address agitated and aggressive behavior maintained by negative reinforcement will be presented, including video. In the final presentation, three cases will be reviewed where token economy-based interventions were utilized to reduce challenging behaviors maintained by positive and negative reinforcement. Discussion of the utility and implications of these papers will be presented as a demonstration of the effectiveness of behavior analysis for treatment of individuals with traumatic brain injuries.
|Instruction Level: Intermediate|
|Keyword(s): Brain Injury, rehabilitation, token economy, verbal operants|
|Target Audience: |
The target audience for this symposium includes practitioners in the rehabilitation fields, individuals working with survivors of TBI, as well as those interested in translational research.
|The Rehabilitation of Verbal Operants Following Acquired Brain Injury|
|DANI LEIGH BUCKLEY (California State University, Sacramento), Kimberly Magat (CSUS), Megan R. Heinicke (California State University, Sacramento)|
|Abstract: Verbal deficits are major concerns for individuals following a traumatic brain injury (TBI). However, behavior-analytic research on language training in neurorehabilitation settings is extremely limited. The purpose of this study was to extend the work of Sundberg and colleagues (1990) in which the authors evaluated functional independence of verbal operants in adults following TBI by assessing which verbal operant (i.e., tact, mand, or intraverbal) would be acquired first and whether direct training of one operant would lead to transfer of untrained verbal operants. We are using a concurrent multiple-baseline design across behaviors to assess acquisition rates of each verbal operant, while conducting generalization probes for others not being directly trained. Thus far, one participant with severe TBI has completed the study, and three participants with moderate to severe TBI are currently in the data collection phase. Our first participant acquired all verbal operants, and we observed the greatest amount of transfer of function in the mand condition. Following the completion of all participants, we will compare rates of acquisition for each verbal operant as well as functional independence across participants.|
|Catastrophic Impact of Brain Injury on Behavior and Community Reintegration: A Case Review|
|CHRIS PERSEL (Centre for Neuro Skills), Anneka Hofschneider (Centre for Neuro Skills)|
|Abstract: Unique behavior challenges can complicate recovery from traumatic brain injury. This case study review will focus on a 49-year-old male who was involved in a motor vehicle accident. Significant impairments were observed following his injury, including deficits and excesses in physical, cognitive, and neurobehavioral domains. Neurobehavioral complications included verbally declining to participate, yelling, pushing, and swatting at others during activities of daily living with episodes lasting three to four minutes in duration. These incidents occurred in the home and community settings. Upon admission to a neurorehabilitation program, problematic behaviors persisted during therapies and transitions with a hypothesized function of escape. Use of differential reinforcement of alternative behavior, reduced demand, hand-over-hand guidance, and a low-stimulating environment facilitated improvements with therapy participation and yelling. Data from baseline to current time, including a one-day reversal, will be reviewed and discussed, as will limitations. Video evidence will assist in the review.|
Planning Your Escape: Environmental Approaches to Behavior Change
|ANNEKA HOFSCHNEIDER (Centre for Neuro Skills), Randy Spence (Centre for Neuro Skills)|
Disruptive behavior including attempts to escape challenges and access tangibles are frequently seen after traumatic brain injuries (TBI). The first case study will be presented on a 60-year-old male who was involved in a motor vehicle accident (MVA) who suffered a TBI. Problematic behaviors such as nonparticipation, confabulations, elopement, and posing a high safety risk warranted functioned-based treatment. An "Early Departure" program was implemented to address exiting and refusals baseline levels of (e.g., 13% exiting and 50% refusals across twelve weeks) to 0% exiting and 25% refusals at discharge. The second case study will be presented on a 38-year-old-female with an acquired brain injury secondary to anoxia. Problematic behaviors included kicking, hitting, biting, nonparticipation, and major sleep-wake disturbances. Implementation of rapport building, planned ignoring, hand-over-hand and differential reinforcement of alternative behaviors resulted in observed participation levels at 100% from 0% at baseline. Additional improvements and positive outcomes will also be discussed. Data and graphical analyses will be presented, along with limitations.
Utilizing and Adapting Token Economies to Address Challenging Neurobehavioral Sequelae for Adults With Traumatic Brain Injury
|CHRIS M. SCHAUB (ReMed), Jennifer S. Croner (ReMed)|
Token economies, through establishing and utilizing conditioned and generalized reinforcers provide a highly effective conceptual and procedural framework in which behavior analysts can work to manipulate types and schedules of reinforcement to produce behavior change. A well constructed token economy can meet essential immediacy requirements to promote the acquisition of behavior as well as allow for the systematic adjustment of types and schedules of reinforcement to strengthen and maintain behavior over time. These properties are especially well suited to addressing challenging behavior in the adult brain injury population. In brain injury rehabilitation, the behavior change process is often complicated by organic deficits such as frontal lobe impairment, memory impairment, anosognosia, etc. The utilization of token economies in working with adult survivors of brain injury with neurobehavioral complications will be discussed, and data will be presented for three adult subjects that demonstrate the efficacy of token economies in implementing differential reinforcement of other and alternative behavior procedures to reduce key target behaviors, including at risk mobility, sexually intrusive behaviors, aggression, etc. Each case will illustrate individualized interventions as well as rehabilitation goals.