Behavioral Neuropsychology: Behavioral Treatment for the Brain-Injured

1. Behavioral Neuropsychology:Behavioral Treatment for the Brain-Injured Prepared by: CiciliaEviGradDiplSc., M. Psi

2. Introduction • Objective generate a workable treatment paradigm to handle problems of management and rehabilitation of brain-impaired individuals  treatment planning and outcome evaluation • Behavioral neuropsychology  application of behavior therapy techniques to problems of organically individuals while applying a neuropsychologically based assessment and treatment perspective

3. Conceptual Models • Diller and Gordon (1981) proposed three conceptual approaches as models of mental life: the chemist (clinical psychologist), the biologist (neurologist) and the behavioral engineer (behavior therapist) • The result was incorporation of conceptual problem selection, task analysis, and treatment perspectives

4. Contd. • Horton and Wedding (1984) described: • Clinical psychologist  utilizes psychometric tests to study mental life and test profile to delineate strengths and weaknesses in functioning  look at test scores • Neurologist  employs knowledge of neurodevelopmental procedures and responses to altered conditions of performance to describe functioning  look at neuroanatomy

5. Behavior therapist  views mental life by observing behavior and abstracting its purpose through the application of S-R contingencies to describe the patient’s functioning  look at behavior • These three components should be integrated in complimentary rather than competitive manner (Diller & Gordon, 1981)  because sophisticated understanding of the three perspective is necessary to facilitate appropriate intervention with the patient and presenting problems

6. Three Professionals • The integration of those three professionals  produce publicly verifiable, objectively stated outcomes and provide behavioral treatment procedures for the application of behavioral neuropsychology in a meaningful way • With careful and thoughtful persistence, therapeutic changes may take place and generalize to new skills, tasks, and settings

7. Lewinsohn’s Model • Remediation of memory deficits in brain-damaged individuals • Steps: • General Assessment of neuropsychological functioning • Specific Assessment of neuropsychological functioning • Laboratory evaluation of intervention strategy • In vivo application of intervention strategy

8. Step 1 • Goal  to understand the patient’s neuropsychological functioning in terms of normative data  comparing with other patients of similar type • Standardized neuropsychological test batteries have significant advantages  Halstead-Reitan Neuropsychological Test Battery, Wechsler, MMPI, Luria-Nebraska Neuropsychological Test Battery  provide data on strength and weaknesses to facilitate treatment planning

9. Step 2 • Goal  understand the patient’s problem in terms of his/her unique individual functioning, the specific parameters of the patient’s problem • Hallmark  behavioral assessment that includes the purpose and personal meaning of patient’s behavior

10. Step 3 • Goal  test the value of specific intervention for the patient’s problem in a controlled environment  in which various parameters of a treatment method can be either held constant or precisely varied  to make precise statements regarding cause-and-effect relationships

11. Step 4 • Goal  to translate the successful laboratory intervention into the real world  is it adequate in a real world? • Two concerns: • Attention need to be devoted to generating occasions of reinforcement for engaging in the preferred intervention • The strength of treatment needs to be considered  specific level of success, adjustment to particular circumstances

12. Contd. • In chronic conditions  need to arrange environmental cues and contingencies in such a manner that the therapeutic intervention is maintained over an extended period of time and over the variety of different situations that the person is likely to encounter • Summary  Lewinsohn’s model provides a valuable paradigm for conceptualizing the steps necessary for clinical intervention with brain-injured patients • Not excluding other neuroscience methods

13. Application • Neuropsychological data  as the based for behavior change procedures • Generalizations are possible, BUT we have to remember the complexity of human brain, how much information is stored in the mind and how creative humans are with mental capacities  how complex in brain injury cases??

14. Activities of Daily Living (ADL) • Goal  help a head-injured person regain their capacity to cope with the activities of daily life  including: • Self-care  eating, drinking, grooming, dressing, personal hygiene, going to the toilet • Domestic duties  cooking, washing up, laundry • Travel  using public transport, driving • Time management and scheduling  organising the day, work and leisure activities, appointments, written schedules, set priorities • Financial skills  shopping, budgeting, banking

15. Physical Rehabilitation • Goal  help patient reclaim as much as physical independence and mobility as possible  redeveloping normal patterns of movement, improving balance and posture, and increasing strength and endurance, also eliminating unwanted movements and postures • Repeated practice in orderly graded stages  methods are varied

16. Contd. • Involved a mixture of special exercises and appropriate recreational and everyday activities  from bed and ward, hydrotherapy pool, corridors, stairs, gymnasium • Passive movements  entirely carried out by someone else • Active-assistive movements  to help establish the correct pattern of movements and to strengthen one’s muscles • Active movements  without therapist’s assistance and are used to improve motor control and strength • Resistive movements  work against force

17. Contd. • Exercises  positioning the body, walking, moving some body parts while sitting or standing, rocking • Mouth exercises and touch (tapping on, vibrating), pressure and heat stimulation

18. Memory Retraining • External aids  electronic devices, diary/memory book (orientation, memory log, calendar, things to do, transportation, feelings log, names, today at work), automatic cuing devices, environmental modifications (post-it, labels) • Internal aids  mnemonic technique (associating pictures, rhyme),

19. Contd. • Learning specific information: • Break up the task into small suitable chunks • Repetition  use the diary and rehearse • Cues or prompts

20. Behavior Modification • Aims  to encourage appropriate behaviors by rewarding them and discourage inappropriate behaviors by withholding the rewards when such behaviors occur • Rewards, time out • Not suitable for all head-injured patients with behavioral problems

21. Other rehabilitation • Speech therapy • Visual and perceptual rehabilitation • Using special workbook or computer exercise drills design to target patient’s specific problems • Including environmental modifications