Use of behavioural contracting to increase adherence with rehabilitation treatments on an inpatient brain injury unit: A case report

Abstract

The patient was able to comply with all requests and, with supports, was able to be safely discharged from the hospital ahead of schedule. Factors that could have contributed to this outcome and potential limitations are discussed.

Interventions to increase engagement with rehabilitation in adults with acquired brain injury: A systematic review

“…All were successful in improving clients' adherence and compliance to rehabilitation. This supports previous research, which suggests that behavioural strategies are most effective where learning paradigms are task-specific, have clearly stated, adaptive goals, are supported by environmental modifications, and are meaningful to the individual (Sohlberg & Mateer, 2001;Ylvisaker et al, 2008;Hufford et al, 2012). However, all of the behavioural interventions characterised engagement in terms of adherence and/or compliance and did not measure the clients' internal motivation or engagement with rehabilitation.…”

“…The use of contingent rewards has been shown to be effective in changing behaviour in a wide range of circumstances. Barrier reduction and behavioural contracting techniques were also shown to be effective in this client group (Newell, 1997;Corrigan et al, 2005;Corrigan & Bogner, 2007;Hufford et al, 2012).…”

“…Eight studies reported interventions using predominantly behavioural modification techniques (Hegel, 1988Zencius, Wesolowski, Burke & McQuade, 1989;Yuen, 1996;Manchester, Hodgkinson, Pfaff & Nguyan, 1997;Newell, 1997;Sohlberg, Lemoncello & Lee, 2011;Hufford et al, 2012), 5 studies primarily cognitive techniques (Pegg et al, 2005;Lane-Brown & Tate, 2010;Skidmore et al, 2011;Hsieh, Ponsford, Wong, Schönberger, Taffe & Mckay, 2012;Hsieh, Ponsford, Wong, Schönberger, Mckay & Haines, 2012) and 2 studies reported a mixture of the two (Corrigan, Bogner, Lamb-Hart, Heinemann & Moore, 2005;Corrigan & Bogner, 2007).…”

“…They are particularly relevant to adults with ABI who, despite experiencing often severe and debilitating cognitive deficits, are generally able to learn new associations and skills that might significantly alter their behaviour (McGlynn, 1990). By targeting behaviour, these interventions circumvent problems arising from a lack of awareness and consequent disengagement from 'unnecessary' rehabilitation often seen in this client group and can be an effective way of increasing adherence/compliance with rehabilitation (Wood, 1987;McGlynn, 1990;Hufford et al, 2012). Interventions focus on altering the environment before (antecedents) or after (consequences) the target behaviour.…”

A Meta-Analysis of Single-Case Research on Behavior Contracts

“…Individuals with disabilities have been participants in much of the research investigating the effectiveness of behavior contracts. Research has included students with emotional and behavioral disorders (EBD; Ruth, 1996), autism (Mruzek, Cohen, & Smith, 2007), attention deficit hyperactivity disorder (ADHD; Gurrad et al, 2002), intellectual disabilities (Jenkins & Gorrafa, 1974), and traumatic brain injury (Hufford, Williams, Malec, & Cravotta, 2012). In addition, several mental health studies have used behavior contracts as part of treatment for borderline personality disorder (L.…”