behavioral neuropsychology: behavioral treatment for the brain-injured

21
Behavioral Neuropsychology: Behavioral Treatment for the Brain-Injured Prepared by: Cicilia Evi GradDiplSc., M. Psi

Upload: chinue

Post on 16-Feb-2016

56 views

Category:

Documents


0 download

DESCRIPTION

Behavioral Neuropsychology: Behavioral Treatment for the Brain-Injured . Prepared by: Cicilia Evi GradDiplSc ., M. Psi. Introduction . - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

Behavioral Neuropsychology:Behavioral Treatment for

the Brain-Injured

Prepared by: Cicilia Evi GradDiplSc., M. Psi

Page 2: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 3: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 4: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 5: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

– 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

Page 6: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 7: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

Lewinsohn’s Model

• Remediation of memory deficits in brain-damaged individuals

• Steps:1. General Assessment of neuropsychological

functioning2. Specific Assessment of neuropsychological

functioning3. Laboratory evaluation of intervention strategy4. In vivo application of intervention strategy

Page 8: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 9: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 10: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 11: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 12: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 13: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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??

Page 14: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 15: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 16: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 17: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 18: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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),

Page 19: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

Contd.

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

Page 20: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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

Page 21: Behavioral Neuropsychology: Behavioral Treatment for  the Brain-Injured

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