Acquired Brain Injury Case Study – an example of how SASBA can be utilised in clinical work (part 5)

1. 3)
   A behaviour-modification intervention was introduced, in which BS had the opportunity to earn points throughout the day by engaging in appropriate social behaviour that was incompatible with TO, VC and NC. Points were accumulated and he exchanged these for tangible rewards of his choice. This also encouraged BS to monitor his behaviour more vigilantly and with increased awareness.
2. 4)
   The MDT agreed that the appropriate response to TO was to ignore and downplay it as much as possible, thereby reducing the likelihood that BS would be reinforced by the attention he previously enjoyed. Instead, attention and praise were consistently available when he engaged in appropriate social interaction.

Outcomes

SASBA was maintained following the introduction of this intervention to enable the MDT to assess its therapeutic effectiveness. Figure 6 clearly shows that there was a decrease in all behaviours captured by SASBA. It also confirms that the worrying increase in TO during the two week assessment period was reversed following the introduction of intervention, and that the frequency of this behaviour was greatly reduced over the course of the 14 weeks that followed. In addition, Figure 7 confirms that SASBA showed an increased reduction in the severity of TO, with the proportion of that behaviour categorised as ‘very severe’ falling from 30% of all incidents to less than 6%.

A major benefit of using SASBA was helping staff to reach an objective understanding of the reasons why BS engaged in behaviour that was found to be objectionable and distressing. When interpreted against the context of knowledge regarding the effects of brain injury on behaviour and cognition, the MDT learned that the social environment they created within the rehabilitation unit inadvertently contributed to TO being not only maintained, but encouraged. Individuals who felt BS was specifically targeting them with his behaviour saw through SASBA recordings that this was not the case. This understanding of BS’s behaviour, and the intervention that was subsequently implemented, empowered staff to respond to him in a consistent and therapeutic manner, which helped their confidence and encouraged them to give him more opportunities for appropriate social interaction. In this regard, SASBA was instrumental in assisting the MDT to see beyond the challenges of BS’s inappropriate behaviour, and helped them to create a social environment in which he was able to thrive.

As for the future? SASBA will continue to record and monitor BS’s behaviour; it is anticipated that his ability to inhibit TO will grow further as the intervention described above is continued. This will eventually be carefully phased out and SASBA maintained to help the MDT ascertain the overall success of this important aspect of BS’s rehabilitation and eventual reintegration back into the community.

Professor Nick Alderman
Associate Director of Neurobehavioural Rehabilitation & Research