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Neuropsychosocial Intervention: The Practical Treatment of Severe Behavioral Dyscontrol After Acquired Brain Injury

2003 Edition, June 26, 2003

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Active, Most Current

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ISBN: 978-0-8493-1244-1
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Product Details:

  • Revision: 2003 Edition, June 26, 2003
  • Published Date: June 26, 2003
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 233
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Motor vehicle accidents. Falls down stairs. Sports collisions. Strokes. Falls off ladders. Drug overdoses. Heart attacks. Muggings. Near drownings. In a brief moment, sometimes a split second, a person's concerns about tomorrow change from the groceries, the rent, a date, mowing the lawn, a promotion, or paying the bills to survival. And then the groceries, the rent ... become important again. Except this time, one has cognitive problems and cannot remember important concerns or one has emotional difficulties and is depressed and irritable.

Beyond these symptoms of cognitive deficits and emotional challenges lies behavioral dyscontrol. Behavioral dyscontrol cannot be ignored, because it interferes with all other treatment and any possibility of success in life after brain injury. Yet behavioral dyscontrol is the problem therapists, families, and persons with brain injury find the most difficult to address. Most therapists are poorly prepared to treat behavioral dyscontrol, particularly when it is severe in nature. Hence, persons with brain injury who exhibit severe behavioral problems may be locked in jail or state hospitals.

This book describes an intervention methodology to address behavioral dyscontrol, even when the behavior is severe. The therapy is called neuropsychosocial treatment. Neuropsychosocial treatment changes the world to fit the needs of persons with brain injury. It is an environmental intervention that focuses on the behavior of the people whom persons with brain injury encounter and the physical environment that they inhabit. Therapists create this environment after they formulate an understanding of the phenomenology of behavioral dyscontrol for each person with brain injury based upon an examination of neurological, cognitive, adjustment, and environmental variables.

The treatment model this book describes differs from traditional interventions in two ways. First, construction of a new environment is the treatment. In traditional treatment, environmental manipulation is used for insight acquisition, skill building, or contingency management. Second, neuropsychosocial intervention works even when the above therapies fail.

This book describes procedures that are based on over 20 years of clinical work with persons with brain injury, 10 of those years specializing in the treatment of behavioral dyscontrol. During that time, the treatment methodology that this book details has been used to successfully address very severe behavioral dyscontrol by persons with brain injury. Persons with brain injury are living in the community today, rather than in jail or a state hospital, because of neuropsychosocial intervention. This book offers therapists a methodology for treatment that works, even with seemingly intractable cases. Of course, therapists may also find the information here helpful to treat less severe behavioral dyscontrol, either alone or in conjunction with traditional therapies.

This book provides an integrated approach for the treatment of behavioral dyscontrol. In contrast, behavioral management techniques are usually presented as a list of strategies as if they were items on a menu. The author of this book believes that such a cookbook approach fails to give therapists guidance in how to organize treatment. For this reason, this book rebalances case conceptualization and techniques. The usual presentation of behavioral interventions focuses on interventions that are too simplistic for true cases of severe behavioral dyscontrol. The author has seen an overwhelming number of cases where therapists have applied various simplistic behavioral strategies, often documented in detailed behavioral management plans numerous pages in length, that do not work. These plans either lack an overall case conceptualization or consist of behavioral tactics that are inadequate. This book, in contrast, presents an integrated approach that includes treatment philosophy and concrete application.

In addition, this book includes discussion of professional issues for therapists who work with persons with brain injury who exhibit behavioral dyscontrol. The application of any behavioral treatment requires very skillful therapists. These therapists face continual professional and emotional hurdles, as treating severe behavioral dyscontrol is difficult work. However, too often, behavioral interventions are presented as if they were a matter of simply implementing textbook tactics. Then, treatment fails when therapists ignore real-world case issues such as treatment setbacks, disruptive families, therapists being hit, team discord, financial concerns, confusion about professional roles, etc. This book interweaves discussion of such issues into the material on clinical work.

Chapter 1 presents the neuropsychosocial approach and outlines its parameters. It contrasts this approach with traditional treatment procedures, noting the problems that therapists have when applying traditional interventions for persons with brain injury. It also discusses the social penalty of inadequate treatment of behavioral dyscontrol.

Chapter 2 reviews cognitive variables that therapists must consider in order to understand behavioral dyscontrol. Too often, therapists devise behavioral plans without careful consideration of cognitive data. Therefore, the emphasis in this chapter is a clinical one: how to link knowledge about cognitive deficits to observed behavioral dyscontrol.

Chapter 3 discusses adjustment factors that have an impact on behavioral dyscontrol. The chapter relates issues of adjustment directly to behavioral dyscontrol. The intent is for therapists to accurately consider adjustment variables that influence the expression of behavioral dyscontrol.

In Chapter 4, therapists will learn the importance of integrating all information at their disposal into a conceptualization of behavioral dyscontrol for each person with brain injury. The chapter discusses the types of team functioning that facilitate the ability of therapists to accurately conceptualize raw observations. Finally, the chapter presents common phenomenological variables that therapists are likely to encounter as they integrate cognitive and emotional data.

Dr. Laura McDaniels provides concrete core behavior plans in Chapter 5. These plans give therapists a place to start for 18 typical problem behaviors. They are intended as initial departure points from which therapists can construct individualized neuropsychosocial environments. In this chapter, Dr. McDaniels also discusses some common modifications of the core plans.

Dr. Robert Sevenich discusses the integration of medication management and neuropsychosocial treatment in Chapter 6. This chapter provides valuable information on an integrated approach for therapists and physicians alike. This chapter will help nonphysician therapists design behavioral treatment with consideration of both the benefit of pharmacological intervention on behavioral dyscontrol and the impact of medications on the application of behavioral treatment. Similarly, this chapter will assist physicians in adequately adjusting medication in light of behavioral plan implementation. Furthermore, Dr. Sevenich reviews specific classes of medications from a clinical perspective as they relate to behavioral management after brain injury.

Chapter 7 tackles the challenge of community placement. First, it addresses the crucial concept of feeling dependent that persons with brain injury must confront. Then, it reviews why there is an inadequate supply of residential options. Next, this chapter reviews how placement sites need to function to handle behavioral concerns and to implement a neuropsychosocial environment. Chapter 7 ends with a discussion of variables that therapists need to consider when preparing to handle episodes of aggression. Therapists need to be ready if their behavioral management plan does not work in every instance. This chapter guides therapists in preparing for unexpected events.

Finally, Chapter 8 presents clinical scenarios that highlight the application of the neuropsychosocial approach. These vignettes bring to life how therapists can assess and conceptualize behavioral dyscontrol and then devise treatment. The vignettes are intended to let therapists see how the process of neuropsychosocial treatment takes shape.

This book was written with the intent of filling a gap in the treatment of behavioral dyscontrol after brain injury. The author's hope is that therapists who apply neuropsychosocial treatment will expand their current armamentarium for addressing behavioral dyscontrol. They will have a coherent way to conceptualize treatment. They will be prepared to integrate cognitive and adjustment variables into a comprehensive model of a phenomenology of behavioral dyscontrol for each case. Therapists will be able to develop and apply concrete behavior plans while considering the advantages of coordinated medication management. Such an approach will enable therapists to apply their expertise in community settings. Finally, they will be better prepared if everything does not work perfectly.

When this book was conceived, it was designed to appeal to a wide range of therapists and others concerned about the need of persons with brain injury to have good behavioral performance. The book's intent is to help psychologists, neuropsychologists, nurses, occupational therapists, physical therapists, speech and language pathologists, behavioral analysts, chaplains, recreational therapists, and other therapists design better treatment. Its goal is also to give physicians information to better integrate their knowledge with behavioral intervention. For social workers, case managers, and third-party representatives, this book should provide insight into what is possible in behavioral management with their assistance as well as what is not feasible. Finally, for family members and persons with brain injury, this book should give hope, tempered by realism. With your help, there is a treatment methodology that works.