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

ABSTRACT

BACKGROUND: This systematic, single-subject case study presents a 37-year old male with a severe traumatic brain injury who exhibited agitation and poor adherence with rehabilitation treatment on an inpatient traumatic brain injury unit. Attempts to address presumed awareness issues were unsuccessful. Medication trials also failed to produce an observable response in the patient's behaviour. CASE STUDY A behavioural contract was presented by staff that specified positive behaviours the patient needed to demonstrate in order to reach his goal of being discharged from the hospital. Immediately, patient agitation ratings decreased and soon normalized. Statistical analysis of single subject times series data using the method of Nonoverlap of all Pairs results in a ratio of 0.875, indicating a moderate effect size for the intervention. CONCLUSIONS: 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.