Therapeutic shock device (TSD): clinical evaluation with self-injurious behaviors.

A man with profound mental retardation and multiple topographies of severe self-injurious behavior (SIB) had been receiving contingent shock for SIB for 2 years before the study started. Shock was being delivered with a handheld shock stick (Hot Shot Sabre Six), which produced burns to the man's skin. SIB rate, without a shock contingency, was 10 responses/min. The Therapeutic Shock Device (TSD), worn by the client and remotely operated by a radio frequency signal, provided superior control of SIB (0.02 responses/min) compared with the shock stick (0.06 responses/min) without causing tissue damage. TSD treatment was introduced in a mixed multiple baseline design across times, settings, and behaviors. The client did not appear to find the TSD aversive. To the contrary, his behaviors indicated that he preferred to wear it. The TSD appeared to provide a substitute for restraint, the hypothesized reinforcer for the man's most frequent form of SIB.

A comparison of shock intensity in the treatment of longstanding and severe self-injurious behavior.

A comparison of shock intensity was conducted while treating a young woman with mental retardation and severe self-injurious behavior (SIB). Two levels of shock intensity were evaluated: 3.5 milliamps (mA) delivered via the Self-Injurious Behavior Inhibiting System (SIBIS) and 18.5 mA delivered via the Hot Shot Power Mite. A combined reversal and multiple baseline across behaviors design was used to evaluate treatment effects. SIBIS in conjunction with differential reinforcement and extinction of self-injurious escape behavior produced minimal reductions in SIB. The Hot Shot combined with extinction of self-injurious escape behavior and reinforcement for compliance resulted in immediate and large reductions in SIB. Residential staff were trained to implement contingencies by the fourth day of treatment with excellent generalization from 30-min sessions to the natural environment across all waking hours. Continuous protective restraints were eliminated within the first month of treatment. Progress occurred in personal care, vocational training, independence, and communication. Treatment effects were maintained for approximately 6 months until a relapse occurred after home visits.

Positive side effects in the treatment of SIB using the Self-Injurious Behavior Inhibiting System (SIBIS): implications for operant and biochemical explanations of SIB.

The rate of self-injurious head hitting was reduced using contingent electric shock delivered via the Self-Injurious Behavior Inhibiting System (SIBIS). Positive side effects indicating an improved affective state and increased interaction with the environment were documented. Treatment gains were maintained at a 1-year follow-up assessment. The consistent reports of positive affective side effects from successful treatment studies using SIBIS and contingent electric shock are noted. Implications for current operant-based theories of SIB based on the communication function of SIB and endogenous opiate mechanisms are discussed.

Suffer the little children: fixed intraoral habit appliances for treating childhood thumbsucking habits: a critical review of the literature.

A critical review of the literature is presented covering the treatment of childhood thumbsucking habits using fixed intraoral habit appliances (hayrake, palatal crib). The habit appliances are classified into type and function. Data is tabulated for key references revealing the fragmented and distorted nature of the literature and its lack of consistency. A chronological approach is presented to confirm the confused and idiosyncratic character of the literature. Information is provided on the early work of Massler and Graber and the paradox of Mack, Korner and Reider. Haryett's seminal studies at the University of Alberta regarding aspects of the treatment used are critically reviewed. Reflections are presented on why Larsson's study, casting doubt on the wisdom of using habit appliances, continues to be ignored. The emergence of the Bluegrass Appliance is discussed in terms of its being a more humane appliance and the seeming reluctance of practitioners to apply it as a kinder form of appliance therapy. Information is reported on the pain and serious injuries inflicted on children by habit appliances. A comparison of the use of appliances in the USA is made with the UK, where fixed habit appliances are not popular. Concludes that fixed intraoral habit appliances are cruel and inflict pain and suffering on children out of all proportion to their necessity. Questions why these appliances continue to be used, implying that it could be a combination of financial inducement, professional insularity and the absence of concerted opposition from behavioural therapists.

Clinical evaluation of the self-injurious behavior inhibiting system (SIBIS).

Five cases involving the treatment of longstanding, severe, and previously unmanageable self-injurious behavior are presented. In each case, the behavior was forceful contact with the head or face, and treatment consisted of mild and brief contingent electrical stimulation, delivered automatically or by a therapist, via the Self-Injurious Behavior Inhibiting System. Results of reversal and/or multiple baseline designs, in which sessions ranged in duration from 10 min to all day across a variety of settings, showed that the effects of the system were immediate and produced almost complete elimination of the self-injurious behavior. Controlled and anecdotal follow-up data for four of the five cases suggest continuing benefits and the absence of detrimental side effects associated with treatment. Potential applications of the device, as well as extensions and limitations, are discussed.

La importancia de la terapia ocupacional a través del cuidado en pacientes psiquiátricos / The importance of occupational therapy by taking care in psychiatric patients

Introducción: El enfermo neuropsiquiátrico requiere de una estancia hospitalaria prolongada por las condiciones de su patología, por lo que es importante considerar a la persona en su aspecto biológico, psicológico y social. La terapia ocupacional es una alternativa y, a su vez, una herramienta que se utiliza como apoyo para la rehabilitación de este tipo de enfermos; además contribuye a que la persona se mantenga activa. Objetivo: Fomentar la integración grupal y el desarrollo de sus capacidades para expresar su creatividad. Metodología: El profesional de enfermería interviene en este proceso de rehabilitación de la enfermedad a través de la incorporación de las actividades que se realizan en la terapia; reincorpora a la persona lo antes posible a su vida cotidiana, familiar y social. La terapia ocupacional es una herramienta terapéutica que le permite al enfermo desarrollar su habilidad mediante actividades encaminadas a responder a las necesidades de tratamiento de cada persona. En algunos casos se implementan estrategias que faciliten la actividad que se está llevando a cabo. Meyer concebía al hombre como un organismo que se mantiene y equilibra en el mundo real, actualizándose a través de una vida activa y participativa. Resultados: A lo largo de la historia de la profesión, la ocupación humana ha sido típicamente clasificada por los terapeutas ocupacionales en tres áreas: autocuidado, incorporación a la vida social y laboral, todas ellas actividades productivas; así también el juego y las actividades de esparcimiento. Conclusiones: La terapia ocupacional juega un rol importante en la recuperación del enfermo neuropsiquiátrico, busca que la persona sea productiva durante su estancia hospitalaria, contribuye a mejorar su condición de salud y lo reintegra a su ámbito social y familiar.

Introduction: The neuropsychiatric illness requires a prolonged hospital stay by the conditions of their disease so it is important to consider the person in their biological, psychological and social. Occupational therapy is an alternative and also a tool used as support for the rehabilitation of such patients, helps the person to stay active. Objective: Encourage group integration and the development of their ability to express their creativity. Methodology: The nurse involved in the rehabilitation process of the disease through the incorporation of the activities taking place in therapy, rejoins the person as soon as possible to your everyday life, family and social. Occupational therapy is a therapeutic tool that allows the patient to develop their skills with activities to meet the treatment needs of each person; in some cases implemented strategies to facilitate the activity being carried out. Meyer conceived to man as an organism that maintains and balances in the real world, updated through an active and participatory. Results: Over the history of the profession, human occupation has been typically classified by occupational therapists in three areas: self-care, incorporating the social and working life, all of these productive activities, also play and leisure activities. Conclusions: Occupational therapy plays an important role in the recovery of neuropsychiatric illness, looking for a person to be productive during their hospital stay, helping to improve their health, and their social reintegration and family.

[Apparative aversive therapy in combination with verbal suggestions in special obsessional syndromes (initial investigation)]. / Apparative Aversionstherapie in Kombination mit Verbalsuggestionen bei besonderen Zwangssyndromen (Erkundungsuntersuchung).

The author restricts the use of aversion therapy by means of deliberate production of pain to obsessional, especially therapy-resistant disturbances of a permanent nature, with consideration being, of course, given to ethical factors. Experiences worthy of generalization are derived from methodically varied courses of treatment, bringing out suggestive moments subliminally involved in any therapeutical situation and also specifically used by the therapist. In addition, the author emphasizes the need for simultaneously developing, besides aversion therapy, positive attitudes and behavior patterns.

Reduction of disruptively loud voice volume using a "tok-back" device.

This study addressed the disruptively loud voice volume of three adult mentally retarded subjects. A reduction in voice volume was affected through the use of the "tok-back" device, a crescent-shaped device made of lightweight plastic, which when fitted over the face covers the mouth and ears and provides feedback on sounds emitted. In Experiment 1, the tok-back was used with two subjects as an aversive consequence to disruptive screaming. The tok-back was placed over the face after each scream and remained in place until the end of a specified period of quiet. Using a multiple baseline across settings design with each subject, results showed a substantial reduction in screaming following the implementation of the tok-back condition. A multi-element design was used in Experiment 2 to compare the effects of baseline, cueing and tok-back conditions on percent of correct responses, responses given in a soft volume, to simple conversational questions with the third subject. Results showed the tok-back condition to result in a higher percent of correct responding then did either the baseline or cueing conditions.

A proposal for a monitoring and aversive feedback device to maintain drug abstinence or controlled drug use.

A device implanted in a patient could monitor blood levels of addictive substances on an intermittent or continuous basis. Excessive levels of a given substance would trigger release of an aversive chemical agent into the bloodstream, in essence creating an artificial allergy. Implications of the concept are discussed.