A behavioural approach to the rehabilitation of severe brain injury.
thesisposted on 19.11.2015, 08:58 by Rodger Llewellyn. Wood
The thesis is divided into five sections:- Section 1 contains two chapters which introduce the problem of severe brain injury and its effect upon the individual in society. Chapter 1 deals with the problem of behaviour as it affects the family and rehabilitation services. It also takes a critical look at the way behaviour disorders have conventionally been described:- using psychiatric terms of reference, and argues that a more precise description can be made using a behavioural perspective. Chapter 2 examines in some detail the major types of behaviour disorder, suggesting a simple taxonomy for such disorders, with the aim of separating neurologically mediated behaviours from those for which some other mechanism is responsible. Section 2 provides a description of the treatment environment and the patients (Chapter 3), and an argument for single-case design methods in this type of research (Chapter 4). The reason for including Chapter 3 is the importance of understanding how this particular behaviour system works, prior to a presentation of the treatment programmes. Section 3 contains four chapters which describe a behavioural approach to the management of different problems in brain injury rehabilitation. Chapter 5 deals with the management of aggression, using single case studies to illustrate the methods used and the outcome of treatment. Chapter 6 presents a group study of 30 patients which shows the effectiveness and generality of a time-out room procedure. Chapter 7 is directed at the management of sexual disorders and unacceptable habits while Chapter 8 demonstrates the application of these procedures in different rehabilitation activities. Section 4 also has four chapters, each dealing with different aspects of attentional problems and their effect on behaviour and the re-learning of new responses. Chapter 9 provides an introduction while Chapter 10 presents a group study showing the involvement of attention in simple discrimination learning. Chapter 11 tries to identify which component of attention is most affected by brain injury while Chapter 12 presents various treatment methods which have been used to improve attentional aspects of behaviour. Section 5 contains Chapter 13 which deals with an important aspect of "personality change" following severe brain injury, in an attempt to determine its relationship to the injury. Finally, Chapter 14 provides a discussion of the major findings and their implication for the development of brain injury rehabilitation. When reading this thesis one must not lose sight of the fact that it descibes the problems presented by the most severe brain injuries, with the exception of those patients who remain in a persisting vegetating state and who, by implication, are not involved in rehabilitation. Although the relative number of patients with these problems is small (approximately 1000 each year), those affected are often young adults, who may have the misfortune of ending up in entirely unsuitable surroundings (geriatric or subnormality wards), simply because some form of suitable management has not been provided to control or eliminate their unacceptable behaviour. (Abstract shortened by UMI.).