Ch 11: Neurobehavioral Complications

Question 1

What is considered to be the most problematic consequence of brain injury by family members, employers, friends, and others?

Answer 1

Neural behavioral and personality changes

Question 2

What triggers anger outbursts?

Answer 2

Frustration
Feeling misunderstood
isolation
decreased concentration

Question 3

Pseudo-bulbar affect (PBA) or emotional incontinence

Answer 3

neurologic condition in which people are prone to sudden unexpected inexplicable and often inordinate episodes of crying or laughing

Question 4

How many individuals pass through agitation as they emerge from coma?

Answer 4

33-70%

Usually brief, lasting less than 10 days

Patients cannot learn new information during this period, avoid consequence-based programming

Question 5

What is the safest and most efficient technique for dealing with coma emergent agitation?

Answer 5

Environmental management where the focus is on offering a quiet, organized, and structured environment with limited and carefully managed stimulation.

Question 6

Behavior

Answer 6

Anything that the individual does that can be measured

Question 7

What is the benefit of direct methods for assessment of behavior?

Answer 7

More reliable since they include direct observations of the individual

Question 8

Functionally equivalent alternative

Answer 8

Behavior that serves the same function as the target behavior but is safer or more appropriate, and that is more useful for the individual

Yelling during PT results in leaving gym

Alternatively teach the individual to ask for rest breaks

Question 9

Latency

Answer 9

The amount of time between stimulus and response

Question 10

Four term contingency

Answer 10

Establishing operation (variable that alters effectiveness of stimulus), Discriminative stimulus (an event or stimulus that precedes a response), Response/behavior (anything that can be done and measured), Consequence (any event that changes the probability of the response in the future)

Question 11

What are the four types of consequences?

Answer 11

There are four different types of consequences:

Reinforcement (+,-)
Punishment (+,-)

Question 12

Reinforcement- what is it and what are the two types?

Answer 12

Refers to any process that increases the likelihood that a particular response will occur again in the future

positive- arrival or delivery of stimulus following a response that makes response more likely to happen in the future
negative- removal of a stimulus following a response makes the response more likely to occur

Question 13

Punishment- what is it and what are the two types?

Answer 13

Refers to any process that decreases the likelihood that a particular response will occur again in the future;
positive- arrival or delivery of stimulus decreases the likelihood that response will occur again
negative- remove of stimulus decreases the likelihood that the response will occur again

Question 14

Factors that influence the type and extent of behavior difficulties

Answer 14

site and severity of damage, pre injury personality, intelligence and learning style, current environment

Question 15

Characteristics of person in coma emergent agitation

Answer 15

sleep wake schedule confused, arousal and attention are impaired, hallucinations or delirium may occur, hyperactive and movements may be without purpose, behavior is bizarre, unpredictable, impulsive, disinhibited

Question 16

Stability Triangle

Answer 16

used for identifying treatment priorities and establishing a treatment plan; establish medical stability, promote behavior stabilities, develop stable activity plan

Question 17

With the goal of applied behavior, what three factors must be considered?

Answer 17

the individual, their environment, the specific behavior that is being targeted for change

Question 18

What is the key step in a behavior assessment?

Answer 18

understanding the function of the behavior, understanding the purpose a behavior serves for the individual in a particular situation

Question 19

Basic guidelines for effective supportive non-verbal and paraverbal behavior

Answer 19

Respect personal space- 1.5 to 3 feet of distance
Keep relaxed posture with both hands in sight
Be aware of own facial expressions and give eye contact
Speak slower and quieter

Question 20

De-escalation techniques

Answer 20

Active listening, orientation, redirection, setting limits, withdrawing attention, contracting (clearly defining expectations)