Martin J. McMorrow

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.

Teaching social skills to psychiatric inpatients

Abstract A social skills training program was evaluated with psychiatric inpatients. The targeted social skills required an action or reaction within six component areas including Compliments, Social Interaction, Politeness, Criticism, Social Confrontation and Questions/Answers . The program used a commerciallyavailable social skills training game that features the use of response specific feedback, self-monitoring, individualized reinforcers and individualized performance criteria. A multiple-baseline design across groups demonstrated that the program increased appropriate responding in all skill areas. Two different generalization tests indicated that the S s used their newly-learned skills outside the training setting. The program appears to be applicable to psychiatric inpatients since it targets skills in a variety of areas and employs standardized procedures to enhance replicability.

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.

Evaluation of a parent's manual for training enuretic children

Abstract An operant method of training enuretic children had previously been evaluated by direct training of the child and parent. A manual describing the method was used by 13 parents in the present study with no professional assistance. Bedwetting was reduced from its pre-treatment level of 68% of the nights to 27% during the first week. 10% during the third month and 7% the sixth month. These results closely approximated those obtained previously with direct training.

The reductive effects of reinforcement procedures on the genital stimulation and stereotypy of a mentally retarded adolescent male

This study evaluated the effects of access to opportunities to earn edibles for performing a high probability stereotypic behavior on the public genital stimulation and stereotypy of a severely retarded male in a special education class. The treatment involved the use of a series of increasing DRO lengths in which the absence of genital stimulation was reinforced with edibles and a stereotypic behavior. Later, we attempted to reduce the rate of stereotypy by withdrawing the edibles that had been provided for it during the reinforcement period. The results indicated that (a) genital stimulation was nearly eliminated with the graduated DRO procedure; (b) withholding the edibles had little effect in reducing the stereotypic behavior; and (c) edibles alone were enough to maintain the reductions in genital stimulation. These findings suggest that public genital stimulation is amenable to treatment with a positive treatment procedure, but more research with the reinforcer displacement technique is needed before any firm conclusions can be drawn about its effectiveness in an applied setting.

Replacing a chronic schizophrenic man's delusional speech with stimulus appropriate responses

This study attempted to extend the use of Cues, Pause, Point language training procedures (developed to treat the speech disorders of mentally handicapped persons) to delusional speech. The direct and potential generalized effects of the procedures on the delusional and socially appropriate responding of an institutionalized, chronic schizophrenic man were evaluated in a multiple baseline design across stimulus-response pairs. The procedures encouraged the subject to (a) remain quiet before, during, and after the presentation of verbal stimuli and then (b) respond on the basis of environmental cues (i.e. written word cards) that contained the correct responses. Delusional responding was rapidly replaced by appropriate responding on both sets of the trained stimuli. Across person and setting generalization occurred in assessments conducted immediately following training, and these effects were maintained for 15 months. The results suggest that Cues, Pause, Point procedures may offer some potential for replacing delusional responding with appropriate responding to social stimuli.

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.

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.

Replacing maladaptive speech with verbal labeling responses: A case study promoting generalized responding

We taught a mentally handicapped student to answer five questions with verbal labels and evaluated the generalized effects of this training on his echolalia and correct responding to five untrained questions. The student received cuespause-point training on an initial five question set followed by generalization assessments on a different set in another setting. Generalization to untrained questions did not occur until training was instituted on two exemplars from the untrained set. These results replicate and extend previous research that suggested that cuespause-point procedures may be useful in replacing maladaptive language strategies by teaching students an alternative strategy that involves using their verbal labeling repertoires. They also suggest that training exemplars is a viable means of promoting the generalized use of this strategy.