Following a traumatic brain injury, patients often suffer a series of psychological and psychiatric sequalae. This study presents the case of Mr. K, a 52-year-old brain-injured nursing home resident who exhibited problematic physical aggression and verbal abuse toward staff and residents. His problem behaviors were intertwined with an ethical issue involving a heterosexual relationship with another resident who also was brain injured. Following a functional assessment of antecedents and consequences, a differential reinforcement of other behavior (DRO) schedule was implemented. Specifically, the resident was rewarded with short-term and long-term reinforcers following periods of time during which behaviors other than the target behavior were emitted. Although the behavior plan was successful, it resulted in a more noticeable decrease in physically aggressive behaviors than verbally abusive behaviors. Implications include increasing awareness of use of behavior plans in nursing homes and of ethical and behavioral issues associated with sexuality among nursing home residents.
Benedict, R.H.B., Schretlen, D., Groninger, L., & Brandt, J. (1998). Hopkins Verbal Learning Test-Revised: Normative data and analysis of inter-form and test-retest reliability. Clinical Neuropsychologist, 12, 43-55.
2.
Bouman, W.P., Arcelus, J., & Benbow, S.M. (2007). Nottingham Study of Sexuality and Ageing (NoSSA II). Attitudes of care staff regarding sexuality and residents: A study in residential and nursing homes. Sexual and Relationship Therapy , 22, 45-61.
3.
Dikmen, S.S., Machamer, J.E., Powell, J.M., & Temkin, N.R. (2003). Outcome 3 to 5 years after moderate to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84, 1449-1457.
4.
Gurvich, T., & Cunningham, J.A. (2000). Appropriate use of psychotropic drugs in nursing homes. American Family Physician, 61, 1437-1446.
5.
Hart, T., Whyte, J., Kim, J., & Vaccaro, M. (2005). Executive function and self-awareness of "real-world" behavior and attention deficits following traumatic brain injury. Journal of Head Trauma Rehabilitation, 20, 333-347.
6.
Hoofien, D., Gilboa, A., Vakil, E., & Donovick, P.J. (2001). Traumatic brain injury (TBI) 10 - 20 years later: A comprehensive outcome study of psychiatric symptomatology, cognitive abilities, and psychosocial functioning. Brain Injury , 15, 189-209.
7.
Kaplan, E.F., Goodglass, H., & Weintraub, S. (1983). The Boston Naming Test (2nd ed.). Philadelphia: Lea & Febiger.
8.
Kiernan, R.J., Mueller, J., Langston, J.W., & Van Dyke, C. (1987). The Neurobehavioral Cognitive Status Examination: A brief but differentiated approach to cognitive assessment. Annals of Internal Medicine, 107, 481-485.
9.
Langlois, J.A., Rutland-Brown, W., & Thomas, K.E. (2006). Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
10.
McAllister, T.W. (1992). Neuropsychiatric sequelae of head injuries. Psychiatric Clinics of North America, 15, 395-415.
11.
McCartney, J.R., Izeman, H., Rogers, D., & Cohen, N. (1987). Sexuality and the institutionalized elderly. Journal of the American Geriatrics Society, 35, 331-333.
12.
Millis, S.R., Rosenthal, M., Novack, T.A., Sherer, M., Nick, T.G., Kreuizer, J.S., et al. (2001). Long-term neuropsychological outcome after traumatic brain injury. Journal of Head Trauma Rehabilitation , 16, 343-355.
13.
Omnibus Budget Reconciliation Act of 1987: subtitle C, Nursing Home Reform: PL100-203. (1987). Washington, DC: National Coalition for Nursing Home Reform.
14.
Ponsford, J. (2003). Sexual changes associated with traumatic brain injury. Neuropsychological Rehabilitation, 13, 275-289.
15.
Rao, V., & Lyketsos, C. (2000). Neuropsychiatric sequelae of traumatic brain injury . Psychosomatics, 41, 95-103.
16.
Saretsky, K. (1987). The right to be human, how one facility cares . Provider, 13, 20-23.
17.
Schretlen, D.J., & Shapiro, A.M. (2003). A quantitative review of the effects of traumatic brain injury on cognitive functioning. International Review of Psychiatry, 15, 341-349.
18.
Simpson, G. (2001). Addressing the sexual concerns of persons with traumatic brain injury in rehabilitation settings: A framework for action . Brain Injury, 2, 97-108.
19.
Thurman, D.J., Alverson, C., Dunn, K.A., Guerrero, J., & Sniezek, J.E. (1999). Traumatic brain injury in the United States: A public health perspective. Journal of Head Trauma Rehabilitation , 14, 602-615.
20.
Vakil, E. (2005). The effect of moderate to severe traumatic brain injury (TBI) on different aspects of memory: A selective review. Journal of Clinical and Experimental Neuropsychology, 27, 977-1021.
Watson, C., Rutterford, N.A., Shortland, D., Williamson, N., & Alderman, N. (2001). Brain Injury, 15, 1003-1015.
23.
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M.B., et al. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37-49.
24.
Yody, B.B., Schaub, C., Conway, J., Peters, S., Strauss, D., & Helsinger, S. (2000). Applied behavior management and acquired brain injury: Approaches and assessment. Journal of Head Trauma Rehabilitation, 15, 1041-1060.
25.
Zimmer, J.G., Watson, N., & Treat, A. (1984). Behavioral problems among patients in skilled nursing facilities. American Journal of Public Health, 74, 1118-1121.
