Brain & Spinal Injury
Welcome to the Brain & Spinal Injury Section
Welcome to the Brain Injury Help Section for the Cambridge Center for Behavioral Studies. Whether a brain injury results from a trauma such as auto or bicycle collision, a fall, sports injury, or medical event such as a stroke, embolism, or loss of oxygen, you will have access to the information you need to learn about brain injury and behavior analysis here at Behavior.org.
Our webpages describe the various aspects of brain injury and many of the behavioral challenges to everyday activities. Sometimes these challenges may be prevalent immediately after an injury; however, it is not uncommon for a person to exhibit problems many years after an injury. These problems may range from confusion and fatigue to severe agitation, aggression, and depression.
You will learn about some of the ABA techniques used in the treatment of brain injury, such as reinforcement, shaping, fading, prompting, fluency, errorless discrimination training and stimulus control.
Many of these techniques can help teach and strengthen daily skills, as well as reduce challenging behaviors that interfere with rehabilitation and successful progress.
Our science dates back many years with contributions from early physiologists, experimental psychologists, and others who conducted groundbreaking experiments using controlled environments to study the behavior of individual subjects. Based on this research, Applied Behavior Analysis has emerged as a comprehensive approach to addressing many of problems encountered by individuals, societies, and cultures. Positive and robust changes in understanding behavior has lead to advances in treating children and adults with Autism Spectrum Disorders, Developmental / Intellectual Disabilities, Geriatrics, and Medicine, as well as the Brain Injury treatment.
Statistics and Prevalence
Behavior Analysis Treatment
Applied Behavior Analysis (ABA) and Brain Injury
Skill Acquisition, Teaching & Rehabilitation
Tutorial: Positive Reinforcement/Structured Feedback, Errorless Learning, and Co-Treatment
Brain Injuries & Behavior Changes
- Decision Making and Planning
- Sequencing and Organization
- Attention and Perception
- Reading and Writing Skills
- Thought Processing Speed
- Problem Solving Skills
- Thought Flexibility
- Safety Awareness
- New Learning
- Muscle Movement and Coordination
- Hearing, Vision, Taste, Smell, Touch
- Sexual Functioning
- Social Skills
- Emotional Control and Mood Swings
- Appropriateness of Behavior (Self-Monitoring Remarks & Actions)
- Reduced Self-Esteem
- Depression (Agitated Type)*
- Anxiety & Frustration
- Anger Management
- Coping Skills
- Irritability or Agitation
- Excessive Laughing or Crying
Right-Side Brain Injury and Behavior Changes
- Visual-Spatial Impairment
- Visual Memory Deficits
- Left-Side Neglect
- Decreased Awareness of Deficits
- Altered Creativity and Music Perception
- Loss of “The Big Picture” Type of Thinking
- Decreased Control Over Left-Sided Body Movements
Left-Side Brain Injury and Behavior Changes
- Difficulties in Understanding Language (Receptive)
- Difficulties in Speaking or Verbal Output (Expressive)
- Catastrophic Reactions (Depression/Anxiety)
- Verbal Memory Deficits
- Impaired Logic
- Sequencing Difficulties
- Decreased Control Over Right-Sided body Movements
Diffuse (Left/Right) Brain Injury and Behavior Changes
- Reduced Thinking Speed
- Reduced Attention and Concentration
- Impaired Cognitive Skills in All Areas
Skills Acquisition, Teaching & Rehabilitation
It is not uncommon for individuals to display a variety of challenging behavioral problems that interfere with rehabilitation, which include agitation, aggression, hostility, as well as depression, loss of motivation, and emotional dysregulation. When these behavioral problems are present, rehabilitation is frequently delayed or postponed indefinitely, which impedes full recovery.
Applied Behavior Analysis has been used in the treatment of these interfering behaviors so that effective rehabilitation can be resumed and bringing hope to the individual and his or her loved ones. Additionally, applied behavior analysis has been used to teach individuals to act upon his or her world more effectively. Among the techniques include Errorless Learning, Shaping and Fading, Fluency, and Precision Teaching.
Skill Acquisitionand Brain Injury
Following a brain injury, an individual may need to acquire lost activities of daily living, academic skills, community skills, or social skills. For decades, applied behavior analysis has provided skill acquisition and teaching techniques to enhance greater independence and quality of life. The literature generated in this area is immense and points to successes in areas never before achieved in education.
Applied behavior analysis has utilized procedures generated from the laboratory and translated into practice:
- Errorless Teaching
- Fluency and Precision Teaching
- Behavioral Momentum
- Shaping, Fading, Prompting, & Modeling
Applied Behavior Analysis and Brain Injury Bibliography
Axelrod, S., McElrath, K.K., & Wine, B. (2012). Applied Behavior Analysis: Autism and Beyond. Behavioral Interventions, 27, 1-15.
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Arikiasamy, C.M., Braunling-McMorrow, D., & Moss, G.R. (1990). The TBI Annual Research Index, Volume 2, Orlando, Florida: Paul M. Deutsch Press.
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Braunling-McMorrow, D. (1997). Promoting effective socialization for persons with brain injury, in Fralish, K. and McMorrow, M., Innovations in Brain Injury Rehabilitation (update), New York, New York: Matthew Bender & Company.
Braunling-McMorrow, D. (1998). Rehabilitation outcomes for life, in Fralish, K. and McMorow, M., Innovations in Brain Injury Rehabilitation (update), New York, New York: Matthew Bender & Company.
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Buzan, R.D., Kupfer, J., Eastridge, D., & Lema-Hincapie, A. (2014). Philosophy of mind: Coming to terms with traumatic brain injury. Journal of Neurorehabilitation, (IN PRESS).
Chapman, S.S., Ewing, C.B., Mozzoni, M.P. (2005). Precision teaching and fluency training across cognitive, physical, and academic tasks in children with traumatic brain injury: A multiple baseline study. Behavioral Interventions, 20, 37-49.
Cowley, B.J., Green, G., & Braunling-McMorrow, D. (1992). Using stimulus equivalence procedures to teach name-face matching to adults with brain injuries. Journal of Applied Behavior Analysis, 25, 461-475.
Crane, A.A & Joyce, B.G. (1991). Brief report: Cool Down: A procedure for decreasing aggression in adults with traumatic head injury. Behavioral Interventions, 6, 65-75.
Davis, P.K. & Chittum, R. (1994). A group-oriented contingency to increase leisure activities of adults with traumatic brain injury. Journal of Applied Behavior Analysis, 27, 553-554.
Dise-Lewis, J.e., Calvery, M.L., & Lewis, H.C. (2002). BrainSTARS. Lash & Associates Publishing/Training, Inc.
Dixon, M.R., Guercio, J., Falcomata, T., Horner, M.J., Root, S., Newell, C., & Zlomke, K. (2004). Exploring the utility of functional analysis methodology to assess and treat problematic verbal behavior in persons with acquired brain injury. Behavioral Interventions, 19, 91-102.
Dixon, M.R., Horner, M.J., & Guercio, J. (2003). Self-control and the preference for delayed reinforcement: An example in brain injury. Journal of Applied Behavior Analysis, 36, 371-374.
Dixon, M.R. & Falcomata, T.S. (2004). Preference for progressive delays and concurrent physical therapy exercise in an adult with acquired brain injury. Journal of Applied Behavior Analysis, 37, 101-105.
Dixon, M.R., Jacobs, E.A., Sanders, S., Guercio, J.M., Soldner, J., Parker-Singler, S., Robinson, A., Small, S., Dillen, J.E. (2005). Impulsivity, self-control, and delay discounting in persons with acquired brain injury. Behavioral Interventions, 20, 101-120.
Dixon, M.R. & Tibbetts, P.A. (2009). The effects of choice on self-control. Journal of Applied Behavior Analysis, 42, 243-252.
Dolezal, D.N. & Kurtz, P.F. (2010). Evaluation of combined-antecedent variables on functional analysis results and treatment of problem behavior in a school setting. Journal of Applied Behavior Analysis, 43, 309-314.
Ducharme, J.M. & Rushford, N. (2001). Proximal and distal effects of play on child compliance with a brain injured parent. Journal of Applied Behavior Analysis, 34, 221-224.
Eastridge, D. & Mozzoni, M.P. (2005). Fluency and functional motor skills following brain injury. Behavioral Interventions, 20, 77-89.
Feldner, M.T., Monson, C.M. & Friedman, M.J. (2007). A critical analysis of approaches to targeted PTSD prevention: Current status and theoretically derived future directions. Behavior Modification, 31, 80-116.
Foxx, R.M., Marchand-Martella, N.E., Martella, R.C., Braunling-McMorrow, D., & McMorrow, M.J. (1988). Teaching a problem-solving strategy to closed head-injured adults. Behavioral Interventions, 3, 193-210.
Fyffe, C.E., Kahng, S., Fittro, E., & Russell, D. (2004). Functional analysis and treatment of inappropriate sexual behavior. Journal of Applied Behavior Analysis, 37, 401-404.
Green, G. (1991). Everyday stimulus equivalences for the brain-injured. In W. Ishaq (ed.), Human behavior in today’s world (pp. 123-132). New York: Praeger.
Geren, M.A., Stromer, R., & Mackay, H.A. (1997). Picture naming, matching to sample, and head injury: A stimulus control analysis. Journal of Applied Behavior Analysis, 30, 339-342.
Guercio, J.M., Dixon, M.R., Soldner, J., Shoemaker, Z., Zlomke, K., Root, S., & Small, S. (2005). Enhancing staff performance measures in an acquired brain injury setting: Combating the habituation to organizational behavioral interventions. Behavioral Interventions, 20, 91-99.
Gurdin, L.S., Huber, S.A., & Cochran, C.R. (2005). A critical analysis of data-based studies examining behavioral interventions with children and adolescents with brain injuries. Behavioral Interventions, 20, 3-16.
Haddock, C.K., Poston, W., & Taylor, J. (2003). Neurocognitive sequelae following coronary artery bypass graft: A research agenda for behavioral scientists. Behavior Modification, 27, 68-82.
Hartnedy, S.L. & Mozzoni, M.P. (2000). Managing environmental stimulation during meal time: Eating problems in children with traumatic brain injury. Behavioral Interventions, 15, 261-268.
Hartnedy, S.L., Mozzoni, M.P., & Fahoum, Y. (2005). The effect of fluency training on math and reading skills in neuropsychiatric diagnosis children: A multiple baseline design. Behavioral Interventions, 20, 27-36.
Hegel, M.T. & Ferguson, R.J. (2000). Differential reinforcement of other behavior (DR0) to reduce aggressive behavior following traumatic brain injury. Behavior Modification, 24, 94-101.
Hegel, M.T. & Martin, J.B. (1998). Behavioral treatment of pulsatile tinnitus and headache following traumatic head injury: Objective polygraphic assessment of change. Behavior Modification, 22, 563-572.
Heinicke, M.R. & Carr, J.E. (2014). Applied behavior analysis in acquired brain injury rehabilitation: A meta-analysis of single-case design intervention research. Behavioral Interventions, 29, 77-105.
Heinicke, M. R, Carr, J. E., Eastridge, D., Kupfer, J. & Mozzoni, M. P. (2013). Assessing preferences of individuals with acquired brain injury using alternative stimulus modalities. Brain Injury, 27, 48-59.
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Jacobs, H. E. (1993). Behavior analysis guidelines and brain injury rehabilitation: People, principles and programs. Aspen, Gaithersburg.
Johnson, K. & Davis, P.K. (1998). A supported relationships intervention to increase the social integration of persons with trumatic brain injuries. Behavior Modification, 22, 502-528.
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Kubina, R.M., Ward, M.C., & Mozzoni, M. (2000). Helping one person at a time: Precision teaching and traumatic brain injury rehabilitation. Behavioral Interventions, 15, 189-203.
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Lash, M., Braunling-McMorrow, D., Tyler, J., & Antoinette, T. (Editors) (2004). Training Manual for Certified Brain Injury Specialists CBIS, Third Edition, American Academy for the Certification of Brain Injury Specialists.
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Luiselli, J.K., Dunn, E.K., & Pace, G.M. (2005). Antecedent assessment and intervention to reduce physical restraint (protective holding) of children and adolescents with acquired brain injury. Behavioral Interventions, 20, 51-65.
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Lutzker, J.R. & Whitaker, D.J. (2005). The expanding role of behavior analysis and support: Current status and future directions. Behavior Modification, 29, 575-594.
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Maki, A.L., Rudrud, E.H., Schulze, K.A., & Rapp, J.T. (2008). Increasing therapeutic exercise participation by individuals with acquired brain injury using self-recording and reinforcement. Behavioral Interventions, 23, 75-86.
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Community Enrichment, Recreation, & Accessibility
A brain injury is a devastating event, but it does not prevent a person from living a rich and fulfilling lifestyle, and with enough planning and support, many people live very productive and happy lives.
Applied behavior analysis can be an important part of this recovery. From learning the necessary pre-requisite skills needed for success in home and community to independent travel and full access, applied behavior analysts assist rehabilitation specialist to promote generalization of skills, increase effectiveness of signs, symbols, and activity schedules, and promote effective problem solving strategies using reinforced practice, role playing, and other simulations.