Behavioural Approaches to Neuropsychological Rehabilitation: Optimising Rehabilitation Procedures (Neuropsychological Rehabilitation)

152 Pages·2003·1.35 MB·English

by  Barbara Wilson

Behavioural Approaches in Neuropsychological
Rehabilitation
Behavioural Approaches in
Neuropsychological
Rehabilitation
Optimising Rehabilitation Procedures
Barbara A.Wilson
Medical Research Council Cognition and Brain
Sciences
Unit, Cambridge and The Oliver Zangwill Centre
Ely, UK
Camilla M.Herbert
The Brain Injury Rehabilitation Trust, Burgess
Hill,
West Sussex, UK
Agnes Shiel
Faculty of Medicine and Health, NUI Galway,
Ireland
HOVE AND NEW YORK
First published 2003
by Psychology Press
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British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Wilson, Barbara A.
Behavioural approaches in neuropsychological rehabilitation:
optimising rehabilitation procedures/B.A.Wilson, C.M.Herbert,
A.Shiel.—1st ed.
p. cm.
Includes bibliographical references and index.
ISBN 1-84169-183-6 (hardcover)
1. Brain damage—Patients—Rehabilitation. 2. Clinical
neuropsychology. I. Herbert, C.M. (Camilla M.), 1962–II. Shiel, A.
(Agnes), 1959–III. Title.
RC387.5.W5448 2003
617.4′810443–dc21 2003005281
ISBN 0-203-64154-X Master e-book ISBN
ISBN 0-203-67912-1 (Adobe eReader Format)
ISBN 1-84169-183-6 (Print Edition)
Contents
Series preface vii
Preface ix
List of tables and figures xi
1 A brief history of behavioural approaches in 1
neuropsychological rehabilitation
2 Assessment for rehabilitation: Integrating information from 6
neuropsychological and behavioural assessment
Background 6
Neuropsychological assessment 6
Behavioural assessment 8
Integrating information from both disciplines 10
Ecologically valid tests 11
Using information from assessments to plan rehabilitation 12
programmes
Conclusions 15
3 Planning a rehabilitation programme using a behavioural 17
framework
Background 17
Single-case versus group designs 18
Types of single-case designs 19
Use of statistics 21
A basic plan for treatment 22
Goal planning in rehabilitation 25
4 Behavioural approaches to assessment and management of 29
people in states of impaired consciousness
v
Introduction 29
Recovery from brain injury 30
Coma 31
The vegetative state 31
The minimally conscious state 32
Assessment 33
Case examples 36
Post traumatic amnesia 38
Behavioural approaches to treatment: Coma, vegetative state, and 41
minimal consciousness
Behavioural approaches to treatment: PTA 42
Conclusion 44
5 Behavioural approaches to the remediation of cognitive deficits 45
Behavioural approaches for increasing or establishing cognitive 45
functioning
Behavioural approaches for decreasing or eliminating inappropriate 55
behaviours
Conclusions 63
6 Behavioural approaches to disruptive disorders 65
Behavioural management of aggression 65
Behavioural management of disinhibited behaviour 78
Behavioural management of sexual problems following brain injury 82
Summary 86
7 Behavioural approaches to cooperation with treatment: The 87
effects of mood, insight, and motivation
Behavioural management of mood disorders 88
Behavioural management of lack of insight and denial of disability 91
Behavioural management of apathy and poor motivation 93
Behavioural management of non-attendance and non-cooperation with 95
rehabilitation
Vulnerable adults and consent to treatment 100
vi
Summary 103
8 Educating staff and family members in the long-term 104
management of behaviour disorders
Staff support and training 104
Family support and family training 108
Summary 114
References 116
Author Index 132
Subject Index 137
Series preface
Rehabilitation is a process whereby people, who have been impaired by injury or
illness, work together with health service staff and others to achieve their
optimum level of physical, psychological, social, and vocational well-being
(McLellan, 1991). It includes all measures aimed at reducing the impact of
handicapping and disabling conditions and at enabling disabled people to return
to their most appropriate environment (WHO, 1986; Wilson, 1997). It also
includes attempts to alter impairment in underlying cognitive and brain systems
by the provision of systematic, planned experience to the damaged brain
(Robertson & Murre, 1999). The above views apply also to neuropsychological
rehabilitation, which is concerned with the assessment, treatment, and natural
recovery of people who have sustained an insult to the brain.
Neuropsychological rehabilitation is influenced by a number of fields both
from within and without psychology. Neuropsychology, behavioural
psychology, and cognitive psychology have each played important roles in the
development of current rehabilitation practice. So too have findings from studies
of neuroplasticity, linguistics, geriatric medicine, neurology, and other fields.
Our discipline, therefore, is not confined to one conceptual framework; rather, it
has a broad theoretical base.
We hope that this broad base is reflected in the modular handbook series. The
first book was by Roger Barker and Stephen Dunnett which set the scene by
talking about “Neural repair, transplantation and rehabilitation”. The second
title, by Josef Zihl, addressed visual disorders after brain injury. Forthcoming
titles include volumes on specific cognitive functions such as language, memory,
and motor skills, together with social and personality aspects of
neuropsychological rehabilitation and behavioural approaches to rehabilitation.
Other titles will follow as this is the kind of handbook that can be added to over
the years.
Although each volume will be based on a strong theoretical foundation
relevant to the topic in question, the main thrust of a majority of the books will
be the development of practical, clinical methods of rehabilitation arising out of
this research enterprise.
The series is aimed at neuropsychologists, clinical psychologists, and other
rehabilitation specialists such as occupational therapists, speech and language
viii
pathologists, rehabilitation physicians, and other disciplines involved in the
rehabilitation of people with brain injury.
Neuropsychological rehabilitation is at an exciting stage in its development.
On the one hand, we have a huge growth of interest in functional imaging
techniques to tell us about the basic processes going on in the brain. On the other
hand, the past few years have seen the introduction of a number of theoretically
driven approaches to cognitive rehabilitation from the fields of language,
memory, attention, and perception. In addition to both the above, there is a
growing recognition from health services that rehabilitation is an integral part of
a health care system. Of course, alongside the recognition of the need for
rehabilitation is the view that any system has to be evaluated. To those of us
working with braininjured people including those with dementia, there is a
feeling that things are moving forward. This series, we hope, is one reflection of
this move and the integration of theory and practice.
REFERENCES
McLellan, D.L. (1991). Functional recovery and the principles of disability medicine. In
M.Swash & J.Oxbury (Eds.), Clinical neurology. Edinburgh: Churchill Livingstone.
Robertson, I.H., & Murre, J.M.J. (1999). Rehabilitation of brain damage: Brain plasticity
and principles of guided recovery. Psychological Bulletin, 125, 544–575.
Wilson, B.A. (1997). Cognitive rehabilitation: How it is and how it might be. Journal of
the International Neuropsychological Society, 3, 487–496.
World Health Organisation (1986). Optimum care of disabled people. Report of a WHO
meeting, Turku, Finland.
BARBARA A.WILSON
IAN H.ROBERTSON
Other titles available in this series:
Neural Repair, Transplantation and Rehabilitation
by Roger A.Barker & Stephen B.Dunnett
Rehabilitation of Visual Disorders After Brain Injury
by Joseph Zihl
Preface
This book describes approaches to rehabilitation for people with acquired brain
injury. It is concerned with how methods from behavioural medicine can be
adapted to alleviate cognitive, emotional, social, and personality problems.
Although some of the people described in the book have mild behaviour problems,
we do not focus on individuals with very severe disruptive behaviour disorders,
such as those described by Wood and Eames (1981), as there is already a
considerable literature concentrating on this group.
Like Levenkron (1987), we see behavioural approaches to rehabilitation as a
“process of clinical reasoning” (p. 384) rather than a fixed set of techniques to be
followed rigidly and adhered to, come what may. It is a process concerned with
improving the everyday lives of people with acquired brain injury and their
families, by enabling us to conceptualise, identify, and measure their problems,
and to plan and implement programmes to reduce difficulties, increase strengths,
and teach new skills. To a large extent, behavioural approaches involve the
application of principles derived from learning theory, or from research in
experimental or social psychology, to the remediation of human problems. Such
approaches emphasise systematic evaluation of the applications (Franks &
Wilson, 1975).
Kazdin and Hersen (1980, p. 287) suggested that followers of behaviour
therapy have four main characteristics:
i) A strong commitment to the empirical evaluation of treatment and
intervention techniques; ii) A general belief that therapeutic experiences
must provide opportunities to learn adaptive or prosocial behaviour; iii)
specification of treatment in operational and, hence, replicable terms; iv)
Evaluation of treatment effects through multiple-response modalities with
particular emphasis on overt behaviour.
It is our contention that these approaches are valuable in neuropsychological
rehabilitation because they benefit assessment, treatment, and measurement of
rehabilitation efficacy.
Despite the wide variety of strategies that have emerged from behavioural
psychology and been applied to medical settings, they tend to share common