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Clinical Case Studies
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Decreasing Physical Aggression and Verbal Abuse in a Brain-Injured Nursing Home Resident

Erin L. Woodhead

West Virginia University, Morgantown

Barry A. Edelstein

West Virginia University, Morgantown

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.

Key Words: behavior modification • long-term care • traumatic brain injury

Clinical Case Studies, Vol. 7, No. 4, 301-312 (2008)
DOI: 10.1177/1534650107309834
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