Restraint Safety: an Analysis of Injuries Related to Restraint of People with Intellectual Disabilities

Abstract

Background There is little research on the safety of the various types of restraint commonly used with individuals with intellectual disabilities who exhibit severely aggressive or self-injurious behaviour. Method This study analysed the use of restraint with 209 individuals with intellectual disabilities over a 12-month period.Results Planned restraint, the use of restraint as a component of a behaviour treatment programme (i.e. planned personal or planned mechanical restraint) was safer than crisis-intervention restraint (emergency personal or emergency mechanical). The overall rate of injuries during restraint was 0.46 injuries per hundred restraints. Restraint was applied 99.54% of the time without injury.Conclusion Restraint was relatively safe and safer than reported in one other study. Planned restraint was safer than emergency restraint. The additional training and programme development associated with planned restraint may have contributed to the greater safety of planned restraint. Due to limited empirical data, restraint safety has yet to be established and this study suggests that restraint should be decreased and closely monitored.

Parent-Guardian Evaluation of Physical Restraint Among Adults with Intellectual Disability: a Social Validity Assessment

“…These results are generally consistent with conventional PR policies mandating that PR must be applied as intervention of last resort, only after less restrictive procedures have been ineffective, and guided by the principle of least restrictive treatment (Sheldon and Sheldon-Sherman 2013). Safety concerns also form the basis of most PR training programs (Lennox et al 2011), including injury prevention (Luiselli 2013;Williams 2009). It is encouraging to find that parents-guardians of individuals with PR endorsed these same guidelines and procedural conventions.…”

Can sensory integration have a role in multi‐element behavioural intervention? An evaluation of factors associated with the management of challenging behaviour in community adult learning disability services

“…Restrictive interventions such as physical restraint, mechanical restraint and seclusion are often used as behavioural support strategies for CB amongst people with a learning disability (Heyvaert, Saenen, Maes, & Onghena, ). However, due to the ethical dilemmas (Wilkins, ) and potential risk of injury (Williams, ) their use is controversial (Jones & Stenfert Kroese, ). Lundstrom et al () assert the use of restraint is still an issue in practice.…”

Social Validity Assessment of Physical Restraint Intervention by Care Providers of Adults with Intellectual and Developmental Disabilities

“…First, the process of holding a person, especially if there is active resistance, is often strenuous, emotionally arousing, and difficult to maintain. This type of interaction poses a second prominent concern, namely, the potential for injury to the implementers and recipients of PR (Spreat et al 1986;Tilli and Spreat 2009;Williams 2009). Third, PR may function as positive reinforcement for some people (Favell et al 1978;Magee and Ellis 1988), thereby maintaining rather than decreasing the behaviors targeted for intervention.…”