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Therapeutic restraint is sometimes required as a component of clinical intervention for persons who have serious behaviour disorders. However, there are few studies that describe empirically the conditions under which restraint is utilized. This project was a retrospective analysis of incident reports on the application of therapeutic restraint with four students (ages 10-16 years) who had acquired brain injury and attended a community-based programme of education and neurorehabilitation. Specifically, situations and interactions were examined that were in effect immediately prior to the implementation of restraint. This antecedent analysis identified several common influences, as well as effects that were unique to individual students. The role of antecedent events as 'precipitants' to restraint and respective treatment implications are discussed. [ABSTRACT FROM AUTHOR]

Typically behaviour management plans attempt to change behaviour by manipulating the environmental consequences of selected behaviour. However, identifying the antecedent events that precede behaviour has also been demonstrated to be an important component of effective behaviour change programmes. The present case presentation attempts to demonstrate how antecedent procedures could be used to effectively manage behaviour problems in individuals with brain injury. Visual inspection of changes in the frequency of physical aggression and self-injurious behaviour of a child with brain injury provides preliminary data supporting the use of an intervention package of antecedent and consequence-based procedures. Clinical implications, limitations and possibilities for future research of antecedent control procedures are discussed.

Deficits in decision-making characterized by failures to respond adaptively to consequences that follow responding are common following brain injury. To examine decision-making about consequences, individuals with and without acquired brain injury responded under different response-reinforcer contingencies. In two control conditions, reinforcement was contingent on responding and response repetition. Results showed responding (pressing four computer keys) by both groups produced similar amounts of reinforcement (money) and highlight equal sensitivity to money as a reinforcer. In subsequent experimental conditions, reinforcement was contingent upon varying responses. Results showed both groups produced variable response patterns, but injured subjects earned less reinforcement than controls. With instructions to vary responding across trials, injured subjects earned similar amounts of reinforcement as controls. Collectively, the results suggest reductions in sensitivity to contingencies may be present following injury and function as one behavioural mechanism of maladaptive decision-making.

The potential clinical and financial advantages of providing neurorehabilitation directly in patients' homes and communities have recently been discussed. However, the specific characteristics and outcomes of a coordinated, interdisciplinary, home-based programme does not currently exist in the rehabilitation literature. The present paper presents patient demographics, type and intensity of services provided, satisfaction measures, and clinical outcomes for 77 brain injured individuals in an attempt to begin to define and evaluate this new level of care. Additionally, the challenges of conducting home-based rehabilitation, and needs for further research are discussed.