Brain Injury

An acquired brain injury (ABI) can bring about a variety of behavioural challenges. Some common problems include disinhibition, poor social awareness, aggression, poor personal hygiene, a lack of initiative and ability to conduct every day activities and difficulties with communication. These deficits can have debilitating consequences for community reintegration and often results in isolation and poor life satisfaction.

The rehabilitation process for individuals with ABI is aimed toward increasing a person’s independence and rehabilitating them back into their community. Applied Behaviour Analysis (ABA) can play an important part in the process of rehabilitation ABA interventions for people with ABI focus on bringing about positive and socially valid change.

Although the challenges experienced by individuals with ABI above are the result of physical brain damage, the behaviour issues are often maintained by their consequences. For example, those working with an individual with ABI may inadvertently reinforce unwanted behaviours by withdrawing a demand when a person becomes angry or verbally abusive. Staff may also create bad habits for clients with brain injury by ‘doing everything for them’ because it can be done faster or because avoids a confrontation or mess. Well-meaning staff may end up carrying out a person’s everyday activities (e.g. making a sandwich or doing laundry) in order to reduce the risk of injury to the client this may comet at the cost of their client’s independence.

One of the most powerful tools that ABA can provide as part of the rehabilitation process is the Functional Analysis of behaviour. Functional Analyses have been used to successfully identify and create successful function based treatment plans within the area of ABI. One such example was carried out in 2004 by Dixon et al. These researchers explored using a FA approach in the assessment and treatment of the problematic verbal behaviour of four adults with an ABI, aged between 20 and 61 years.  Four 10 minute FA conditions were set up (attention, demand, alone and control) and the participant received what the condition offered contingent on the occurrence of the target behaviour.

Once the function of each individual’s behaviour was identified, a Differential Reinforcement of Alternative (DRA) behaviour procedure was successfully implemented using a reversal design to demonstrate treatment effectiveness. Appropriate verbal behaviour was reinforced by achieving its function; inappropriate utterances were placed on extinction.

Within the area of communication, behavioural treatment plans may involve scripting or the use of alternative sources of communication such as the Picture Exchange Communication System (PECS). These can be highly useful in helping a person with an ABI to move past their communication deficit and emerge from their isolation. Any ABA intervention for persons with ABI will be individualised to the client’s own strengths and needs.  For examples of ABA interventions for individuals with ABI, please see the readings suggested at the end of this article on functional communication training (FCT) and the treatment of Acquired Apraxia of Speech and Aphasia.

Further Reading

Dixon, M.R., Falcomata, T., Guercio, J., Horner, M.J., Newell, C., Root, S., & Zlomke, K. (2004). Exploring the utility of functional analysis methodology to assess and treat problematic verbal behaviour in persons with acquired brain injury. Behavioural Interventions, 19, 91-102

Hancock, A.B., Youmans, G., & Youmans, S.R. (2011). Script training treatment for adults with apraxia of speech.  American Journal of Speech-Language Pathology, 20, 23-37.

Goldberg, S., Haley, K.L., & Jacks, A. (2012). Script training and generalization for people with aphasia. American Journal of Speech-Language Pathology, 21, 222-238.