Antecedent management and compliance training improve adolescents' participation in early brain injury rehabilitation

Children and adolescents with serious brain injuries are surviving in greater numbers, often entering rehabilitation settings while still emerging from coma. As the child's or adolescent's level of consciousness improves, increased demands to begin participating in self-care and therapeutic activities are presented. When the patient is unable to participate because of disorientation and agitation, the benefits of the rehabilitation admission may be jeopardized, limited rehabilitation resources may be prematurely exhausted, and behavioural sequelae often escalate. A non-concurrent multiple baseline across subjects experimental design was used to examine the effects of a behaviour management approach employing both antecedent environmental manipulations and operant conditioning-based compliance training. Data are presented on therapy attendance, disruptive behaviour, and agitation ratings across three recently brain-injured adolescents as therapeutic demands were gradually introduced. In all three cases, therapy attendance stabilized at a high level, disruptive behaviour decreased, and agitation was maintained at a moderate to low level. The results demonstrate the importance of carefully controlling the environment and coordinating the introduction of both therapeutic demands and positive reinforcement contingencies during early recovery from brain injury.