Assessing preferences of individuals with acquired brain injury using alternative stimulus modalities.

PRIMARY OBJECTIVE: To extend previous research on alternative stimulus preference assessment (SPA) modalities to individuals with severe ABI by evaluating the effects of pictorial, verbal and tangible item presentation. RESEARCH DESIGN: Paired-stimulus procedure used for SPA sessions with the order of modalities counterbalanced across participants. Reinforcer assessments (RAs) were experimentally evaluated using an alternating treatments design. A progressive-ratio procedure was used for reinforcer assessment (RA) sessions. METHODS AND PROCEDURES: Six adults with severe ABI. The Assessment of Basic Learning Abilities was conducted to assess discrimination skills; the Reinforcer Assessment for Individuals with Severe Disabilities structured interview was administered to identify items for subsequent evaluations. Three SPA sessions-one of each stimulus modality-were conducted with each participant. Subsequent RAs were conducted using the stimuli ranked as the most highly preferred for each participant. MAIN OUTCOMES AND RESULTS: Each modality identified a different food item with the highest selection percentage for three participants, while three participants had highly consistent SPA results. Subsequent RAs demonstrated that all modalities made valid predictions of foods that would function as reinforcers for programming. CONCLUSIONS: Use of the different direct-observation methods to identify reinforcers for reductive and skill acquisition programming would likely be a useful addition to rehabilitation settings.

Philosophy of mind: coming to terms with traumatic brain injury.

INTRODUCTION: Patients and their families struggle with accepting changes in personality after traumatic brain injury (TBI). A neuroanatomic understanding may assist with this process. OBJECTIVES: We briefly review the history of the Western conceptualization of the Self, and discuss how neuroscience and changes in personality wrought by brain injuries modify and enrich our understanding of our selves and our patients. CONCLUSION: The sense of self, while conflated with the concept of a "soul" in Western thinking, is more rationally considered a construct derived from neurophysiologic structures. The self or personality therefore often changes when the brain changes. A neuroanatomic perspective can help patients, families, and clinicians accept and cope with the sequellae of TBI.