Why is behavior management needed sometimes?
- It is needed for inappropriate and difficult behaviors that can result from dementia, delirium, frontal lobe impairment, brain injuries, and mood disorders
How can behavioral problems be a burden?
- Time-consuming
- Complicate ADLs
- Stressful for caregivers and healthcare professionals
- Financial cost of managing behaviors
What is behavior?
Behaviors can be a normal part of the recovery process, but must be dealt with productively so they do not lead to long-term destructive patterns of interaction
What is the intent of the behavior?
- Always look at intent of behavior
- Is the person trying to communicate a need, desire, or wish?
- Is the person trying to cope with a stressor (acute or chronic)
- Is the person displaying behaviors due to sensory impairment?
Why is it important to consider Maslow’s Hierarchy of Needs when assessing a client with behaviors?
- Are the individual’s basic needs being met?
- What is the individual’s emotional condition and background?
- What is the client’s baseline for communicating and coping?
- Are safety and security measures being met?
What should you assess in an environment?
- Where are you and the client in relation to the exit?
- Are there any possible dangers?
- Do you need help? If so, how do you get it?
- Are there any objects that could potentially be used as a weapon?
What should a therapist assess about oneself?
- What is your emotional and physical status?
- Will you ask for help?
- Are you capable of managing yourself?
- This is about helping others manage themselves, not about you controlling them
What is behavior like following an injury?
1) Verbal outbursts
2) Physical outbursts - pacing, throwing objects
3) Egocentrism
4) Sexually inappropriate
5) Rigidity/inflexibility
6) Impulsivity
7) Limited self-awareness
What are the ABC’s of behavior?
- Antecedent: occur before behavior and are under staff/caregiver control
- Internal factors: fatigue level, sensory sensitivity, does the person have seizures?
- External factors: are used to decrease likelihood of outbursts by changing tone of voice, changing the setting, or grading the activity
- Behaviors: observable. Develop a program with clear and concise directions
- Consequences: occur after behavior and make it less/more likely to happen again. Use reinforcement as opposed to punishment
What are signs of behaviors?
- Attempt for one to remove himself from task by pushing away activity or table
- Increase in non-purposeful body movement, fidgeting, or self-stimulating
- Loss of eye contact
- Verbal comments indicating that the task is too difficult or frustrating
- Increase in respiration, skin flushing
What should a therapist do if their patient is demonstrating unwanted behaviors?
- Remain calm and use quiet voice
- Remain concrete in responses
- Be consistent in responses
- Don’t overstimulate
- Be patient
- Treat patient as an adult
- Redirect the patient
- Take path of least resistance - if they are not hurting themselves or others then let them continue with group or activity
What are the steps to deal with dangerous behavior?
Step 1: remain calm and in control
Step 2: tell someone to notify supervisor or other qualified personnel in the area to provide assistance. Make sure they understand the urgency of the situation
Step 3: continue to speak in a calm, soft voice and tone
Step 4: move patient to a quiet area. Remove stimulation. One-to-one interventions are most effective
Step 5: re-direct attention and activity away from the agitation, incident, or situation
Step 6: if agitated behavior persists or escalates, or if additional personnel are delayed, change tactics. Know the security codes at different facilities
Step 7: follow-up with an incident report for the Medical Record. Incident report is for any change that you did not expect during treatment (ex: falls)
What can be changed in the environment to decrease stimulation?
- Keep TV and radio to minimum
- Create a quiet environment
- Keep conversations and number of people talking to a minimum. This is difficult when family and friends come to visit
- Keep environment consistent - if you move furniture or items around make sure you explain why and return them to their original place
How can communication decrease unwanted behaviors?
- Speak slowly and in a normal tone and volume
- Give patient time to respond to conversation or command
- Use short simple sentences and repeat if necessary
- If patient is perseverating, remind them that they are perseverating and switch activities
- Forced choices - give patient a limited set of options
- Avoid sarcasm
- Avoid putting person “on display”
What are non-pharmacological treatments for problem behaviors?
- Relaxation techniques
- Distraction
- Redirection
- Reality orientation
- Group programs
- Validation therapy
- Attitude therapy
What is redirection?
- Appearing to agree with the person but helping person go in a different direction physically or conversationally without them thinking they are being forced to do something
What is reality orientation?
- Provide client with frequent reorientation to time, place, person, and situation
When is validation therapy appropriate?
- Recognizes that “reality” is altered
- Time - not necessarily sequential, bounces around from past to present to future
- Memory - familiar people become strangers, past mixes with present, but the real world will not define the dementia world
- Emotions - difficulty with interpreting spoken language but can read non-verbal communication if it is amplified
What is validation therapy?
- Non-confrontational process
- Validates or accepts values, beliefs, and the reality of the person with dementia
- “Agrees” with what they want but by conversation person is steered to do something else without the person realizing that they are being redirected
- Identifies unmet needs
- When feelings are expressed and validated, feelings lose their strength
What are examples of validation techniques?
- Rephrase - repeat the client’s key words
- Mirror their tempo and movements
- Reflect the look in their eye
- Listen to their verbs and use their preferred sense
- Ask extreme questions - “how bad” or “how often”
- Reminisce
What is attitude therapy?
- Developed as a method to manage situational emotional disorders which focuses on relationship approaches
What is the active friendly attitude approach?
- Useful for building self-esteem. Client is actively sought out, praised for recognizable success, and dealt with in an unconditional and warm manner
What is the passive friendly attitude approach?
- Waiting for client to invite you into conversation or relationship. Once invitation is extended, you can respond with a more active and friendly approach
What is the mechanical attitude approach?
- Allowing client to experience natural consequence of behavior without praise or criticism
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Motor Control64
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Neurologic Assessment34
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Occupational Therapy Process15
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Neurodevelopmental Treatment65
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Sensation48
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Vision and Visual Perception Overview13
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Acute Care35
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Neurologically Impaired UE37
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OT Interventions in Neuro7
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Aphasia25
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Motor Perception/Apraxia30
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Influence and Effects of Perception Dysfunction30
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Cognitive Capacities and Abilities53
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Cognition and Interventions17
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Red Flags for Motor Dysfunction7
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Red Flags for Sensory and Visual Impairment25
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Adult Dysphagia9
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Feeding and Eating6
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Positioning in Long-term Care24
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Traumatic Brain Injury38
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Behavior Management31
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Sexuality19
