John M. Guercio

Using stimulus equivalence technology to teach emotion recognition to adults with acquired brain injury.

The purpose of this study was to use stimulus equivalence technology to teach emotion recognition skills to three adults with acquired brain injuries. A pre-test, post-test design was employed to test for acquisition of the facial recognition skills after training. Computer presentation of the stimuli was used. A pre-test was conducted, in which participants’ abilities to expressively label facial representations of emotions and match distinct representations of emotions to other representations depicting the same emotion were examined. Next, participants received matching-to-sample training, in which they were first taught to receptively identify the facial representations of the basic emotions happiness, sadness and anger. They were then taught to receptively identify facial representations of those same emotions that were different from the first representations. When mastery criterion was attained, a post-test identical to the pre-test was presented. Results showed that the participants were able to demonstrate increased facial-emotional recognition skills after training.

Road to awareness: an individualized training package for increasing knowledge and comprehension of personal deficits in persons with acquired brain injury

Research suggests that awareness of ones deficits may be a significant factor in the recovery process after acquired brain injuries (ABI). Various methods have been employed to teach awareness of the potential sequelae of ABI. The present study extended the use of a board game format to teach awareness to adults with ABI who exhibited serious unwanted behaviours. It used an individualized training package in conjunction with a game format in order to more specifically target individual client awareness of personal deficits in two areas: cognition and behaviour. Training focused on the first three levels within Blooms Cognitive Taxonomy: knowledge, comprehension, and application. Components of both the multiple-baseline and multiple-probe design were used to demonstrate experimental control. All three participants responded favourably to training, as evidenced by increases in percentage of questions answered correctly during the game sessions and in pre/post-generalization probes in both cognitive and behavioural categories.

Self-management in the treatment of ataxia: a case study in reducing ataxic tremor through relaxation and biofeedback.

This study examined the effects of relaxation training and biofeedback on the ataxic tremor of an adult with an acquired brain injury. The participant was taught relaxation techniques before biofeedback was introduced. Once he was proficient in relaxation, these skills we used as a foundation for biofeedback training. Specific skills crucial to the performance of activities of daily living were trained once the participant was able to control the appropriate musculature according to an individualized criterion level. These skills included eating and the transfer of liquids in a glass. The results demonstrated that the participant learned to decrease the amount of tremor that he experienced. As a result he was better able to feed himself and to drink from a glass with less staff assistance than he had previously required.

BEHAVIORAL TREATMENT FOR PATHOLOGICAL GAMBLING IN PERSONS WITH ACQUIRED BRAIN INJURY

The present investigation examined a behavior-analytic clinical treatment package designed to reduce the pathological gambling of 3 individuals with acquired brain injury. A prior history of pathological gambling of each patient was assessed via caregiver report, psychological testing, and direct observation of gambling behavior. Using an 8-week one-on-one client-patient format, a treatment program was developed in which the patient learned about the antecedents, consequences, and motivating operations that controlled the emission of gambling behavior. Data were collected on both self-report of gambling urges and behavior following therapy and during in situ gambling opportunities. The therapy program reduced urges to gamble and actual gambling for all patients. The potential of behavior-analytic therapy for reducing the pathological gambling of patients with and without brain injury is discussed.

The Observer Effect and Its Impact on Staff Behavior in an Acquired Brain Injury Neurobehavioral Treatment Setting

Staff in three neurobehavioral residential settings (5 in each residence for a total of 15 staff) were trained on specific positive interaction behaviors in a multiple baseline design. Staff in each of the residences were provided with recommended behaviors for interacting with residents through an observational procedure where they observed and completed checklists on video models of the targeted staff interaction behavior. In addition to staff interaction behaviors, subsequent levels of adaptive resident behaviors were also examined, such as active engagement and indices of happiness. Targeted interactions increased from an average of 7.2% of intervals during baseline to 80% during the intervention. Productive involvement engaged in by residents increased from 17.9% in baseline to 73.9% during the intervention, and the happiness indices of residents increased from 6.1% in baseline to 67.5% during the intervention.

A personal intervention substance abuse treatment approach: Substance abuse treatment in a least restrictive residential model

The following paper will detail demographic information about alcohol and substance abuse issues in the acquired brain injury (ABI) population. Included in such a review will be a systematic presentation of the current data on the incidence of such issues as well as a comprehensive treatment model with outcome data provided. Pre- and post-test measures of separate functional outcome areas were employed to assess the effects of the treatment package. The paper will document the core elements of a substance abuse treatment programme that is based upon community inclusion and positive, proactive treatment methods in facilitating decreases in substance abuse behaviour. The programme employed a host of individual and group session protocols specifically targeted at education and self-monitoring of behaviour in order to facilitate more effective self-control of addictive behaviours. The positive outcomes achieved by the participants involved in the study provide clinical justification for a proactive behavioural approach to substance abuse in the ABI population.

Increasing functional communication through relaxation training and neuromuscular feedback

The following research examined the effects of behavioural relaxation training and biofeedback on ataxic tremor of an adult with acquired brain injury. The paticipant was taught relaxation techniques before biofeedback was introduced. Once he was proficient in relaxation, these skills were then used as a foundation for biofeedback training. Specific skills, facilitating the use of a letter board, were taught when the participant was able to relax the appropriate musculature to criterion. The results demonstrated that the participant learned how to significantly decrease the severity of tremor. As a result, he became more proficient at communicating via his letter board. Collateral effects were increased attempts at communication and fewer episodes of anger.

Improving the Quality of Staff and Participant Interaction in an Acquired Brain Injury Organization

Weekly observations of direct-care staff in a facility for persons with brain injury yielded less than optimal interactional style with facility residents. Following an observational baseline, staff were asked to self-rate a 15-min video sample of their interaction behavior with participants on their unit. They were then asked to compare their self-ratings to those of a supervisor, as well as view a video exemplar of appropriate positive interaction behavior. Elements of their interactional style were highlighted and specific feedback was provided on how to improve their performance. Interaction style was then reevaluated via an unobtrusive observer and yielded positive gains for all participants. Subsequent on-the-job feedback sustained performance gains.

Increasing functional rehabilitation in acquired brain injury treatment: effective applications of behavioural principles

This paper investigated ways to increase the participation of direct care staff in the functional rehabilitation activities (FRAs) of adults with acquired brain injuries (ABIs). FRAs were rehabilitation agendas written by clinical staff for delivery by paraprofessionals. Increases in FRA completion were believed to be directly related to clinical success. These FRAs had been identified as key components in the rehabilitation programmes of the adults living within the residential facilities. Increases in FRAs were crucial in improving the quality of the rehabilitation programmes of the participants involved. The study observed four residential settings serving adults with ABIs using a multiple baseline design. The treatment approach consisted of public posting of weekly FRA documentation, incorporation of staff input, and reinforcement for documentation of FRAs. The results indicated a positive impact on the participation of staff in all of the residences in the study, consistent with implementation of the treatment package.

A treatment selection model for weight reduction in adults with acquired brain injury: applications and preliminary findings.

This article presents a unique method for providing weight management assistance to persons who have experienced an acquired brain injury (ABI). Most of the available literature on this topic deals with weight loss methods for individuals who are not faced with the cognitive and behavioural challenges inherent in this population. A treatment selection protocol will be described that allows for appropriate selection of behavioural weight loss interventions. Interventions are based upon specific cognitive and behavioural difficulties that individuals with acquired brain injury may present. A detailed case study will also be presented depicting successful use of the treatment selection model with an adult male with an acquired brain injury.