ABA-International Conference 2009 blog: "ABA Interventions for Persons with Acquired Brain Injuries"

This symposium at the ABA-International Annual Conference in Phoenix, AZ addresses the topic of Acquired (ABI) and traumatic (TBI) brain injury and rehabilitation techniques.

Acquired Brain Injury (ABI) and Traumatic Brain Injury (TBI), are together two of the most common causes of disability and death in the U.S.. Every year 1.5 million Americans experience a brain injury and 80,000 suffer from long-term disability due that insult. The National Center for Injury Prevention and Control, Centers for Disease Control, estimates that at the present time at least 5 million Americans are living with a TBI-related disability.

Brain injury can occur through a traumatic physical event (falls or other accidents; either closed (no break in the skull) or penetrating (break in the skull). It can also occur in situations where oxygen to the brain is compromised or other neural damage occurs (anoxia, electric shock, vascular disruptions, disease, tumors, poisoning, etc.). The brain injury can be focal (confined to a localized area) or diffuse. The severity can range from concussion to coma or death.

In the aftermath of a serious traumatic or acquired brain injury, there can be a variable and complex combination of deficits: cognitive, motor, perceptual or sensory, communication and language, functional, and regulatory. There can be personality or psychiatric changes, and in a small percentage, traumatic epilepsy. In the more severe cases of brain injury, a client can typically expect 5 to 10 years of intensive rehabilitation. The National Institute of Neurological Disorders and Stroke notes some caution be exercised in prescribing medications because TBI patients are more prone to side effects and adverse reactions.

Definition: Acquired Brain Injury
An acquired brain injury commonly results in a change in neuronal activity, which effects the physical integrity, the metabolic activity, or the functional ability of the cell. An acquired brain injury may result in mild, moderate, or severe impairments in one or more areas, including cognition, speech-language communication; memory; attention and concentration; reasoning; abstract thinking; physical functions; psychosocial behavior; and information processing.
Adopted by the Brain Injury Association Board of Directors, March 14, 1997.

Video: "Living With Traumatic Brain Injury" 29:11

http://www.youtube.com/watch?v=FgtHvBF4t-E

In 1998, the NIH held a Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury. The Consensus Development Panel recommended that TBI patients

"...receive an individualized rehabilitation program based upon the patient's strengths and capacities and that rehabilitation services should be modified over time to adapt to the patient's changing needs..."

National Institutes of Health Consensus Development Conference Statement, October 26-28, 1998. Rehabilitation of Persons with Traumatic Brain Injury. Bethesda, MD, September 1999.

Behavior analysts working in this area should expect to be working in a multidisciplinary team environment, since a full menu of services must be available to meet unique client needs and the extremely individualized treatment required in brain injury rehabilitation.

For more information, see the Brain Injury Section of the Cambridge Center for Behavioral Studies.

-----------------
#25 Symposium
5/23/2009
1:00 p.m. - 2:20 p.m.
North 222 C
CBM; Applied Behavior Analysis
ABA Interventions for Persons with Acquired Brain Injuries
Chair and Discussant: Michael P. Mozzoni (Learning Services NeuroBehavioral Institute of Colorado)

Efficacy of Behavioral Relaxation Training for Individuals with Traumatic Brain.
DIXIE EASTRIDGE (Learning Services NeuroBehavioral Institute of Colorado)

Abstract:

The purpose of this study was to determine if a behavioral approach for relaxation training benefits individuals who display significant agitation following a traumatic brain injury. The study was based on the basic premise that “a relaxed person engages in overt motoric behavior that is characteristic of relaxation “ and by practicing these overt skills they actually become relaxed. Results indicated that participants of this study who experienced disability following traumatic brain injury were able to learn relaxation using Poppen's Behavior Relaxation techniques. The first participant was able to achieve eight of ten postures rapidly. However, the rate the participant was able to learn and engage in relaxed postures in the training phase was significantly affected by medication changes. After the initial relaxation session, medication changes began that had a significant impact on the ability of the participant to remain in the relaxed positions. Following feedback in the first session, the participant was able to average 6.8 of the ten relaxed positions in a five minute session; medication changes began three days later that resulted in the individual being unable to remain in a five minute session in a relaxed position and the session ended after one minute

Precision Teaching and Traumatic Brain Injury.
TAMRY L JUNTUNEN (The Chicago School of Professional Psychology)

Abstract:

The purpose of this study was to assess the utility of SAFMEDS training on tacting in a 57-year-old Caucasian male with an acquired brain injury resulting from cardiac arrest secondary to electrocution who was 35 years post injury. Two primary SAFMEDS decks were used, each containing thirty-five cards. All cards displayed color pictures of items relating to activities of daily living. Correct responses were counted as any vocal response that would lead to acquisition of the desired item in a natural environment. The decks of cards were split into several decks. Varying amount of cards and time limits were used to evaluate which procedure works best in the TBI population. Results indicate that tailoring the exposure to each stimulus may result in faster acquisition of desired information. Smaller decks or increased exposure to stimuli was the best procedure for this individual. Results suggest that individuals with TBI may benefit from Precision Teaching methodology, specifically when the procedures are adapted to the individual client.

Use of a Token Economy to Increase Staff Acceptance in a Person with an Acquired Brain Injury.
ABRAHAM SAENZ (Learning Services of Northern California)

Abstract:

Persons with Acquired Brian Injuries (ABI) present with a variety of challenging behaviors. Frequently these challenging behaviors interfere with therapy, social relationships and community independence. Awareness deficits often result in poor cooperation and active resistance to rehabilitation interventions. When internal motivators cannot be accessed, external motivators may be used to increase cooperation. Cooperation with therapeutic instructions and safety precautions can make the difference between eventual independence and supervised living. In this study a token economy was used in a multiple baseline to decrease physical and verbal aggression and increase cooperation across 2 participants in a residential post acute treatment program. Frequent “cash in “ opportunities and meaningful reinforcing activities arising from reinforcer assessments were critical to getting the clients to buy into the token system. Results indicate that staff training and consistent checks of therapeutic integrity are essential to program and client success.

------------
Related presentation:

#85 Panel Discussion
5/23/2009
4:00 p.m. - 4:50 p.m.
North 224 A
CBM; Applied Behavior Analysis
Data Issues in NeuroBehavioral Rehabilitation
Chair: Michael P Mozzoni (Learning Services NeuroBehavioral Institute of Colorado)

NATILIE JACOME (Learning Services NeuroBehavioral Institute East)
LINDSAY VEIT (Learning Services of Raleigh/Durham NC)
MICHAEL P MOZZONI (Learning Services NeuroBehavioral Institute of Colorado)

#149 Paper Session, 5/24/2009, 9:00 a.m. - 9:50 a.m., North 224 A
CBM
Diverse Applications of Behavior Analysis
Chair: Charles Gilpin (Missouri State University)

A Review of the Current Executive Functioning Interventions for Individuals