Rehabilitation in the absence of vocal communication is a multifaceted obstacle course for individuals with an acquired brain injury (ABI) and health professionals.  A communication hypothesis assumes that some problem behaviour “may be viewed as a non-verbal means of communication” (Carr & Durrand, 1985, p. 111). According to this hypothesis though they differ in form, problem behaviour and verbal communicative acts can share the same function; therefore, by strengthening communicative behaviour one would expect to see a weakening in problem behaviour.  

An exploration of two case studies will be presented that demonstrates individualized techniques to assess the function of challenging behaviour using functional behaviour assessment techniques, teach functionally equivalent alternative communication response, and enhance conversation through teaching the Picture Exchange Communication System. 

The two individual’s discussed each faced unique rehabilitation needs, varied from low to high functioning cognitive levels, and experienced moderate to severe challenging behaviour that required individualized behavioural support programs. In all cases, a variety of strategies were utilized to improve communication methods including functional communication training (FCT),  the Picture Exchange Communication System (PECS) and augmentative and assistive communication devices (AAC. FCT involves the delivery of the putative reinforcer contingent on the emission of a newly trained communicative response (Durand, 1990) and has been associated with a decrease in challenging behaviour using an antecedent based approach. PECS is easily learned by both clients and support staff and associated with corresponding increases to vocal language and reduced problem behaviours (Bondy, 2001), while AAC devices can be used to assist with expressive and receptive communication and are discrete and portable in today’s society. 

Case studies will include a review of behavioural data demonstrating a reduction in challenging behaviour when the teams focused on enhancing communication strategies, and a reduction in the need for more intrusive intervention components including psychotropic medication. Personal reflections from frontline staff and family members demonstrating the social validity of such an approach. 

The use of the results of neuropsychological assessments to guide program design will be discussed as will the need for prolonged learning timelines for post-acute clients. This presentation will focus on the need for trans-disciplinary collaboration between psychiatry, speech and language pathology, behaviour analysis and frontline rehabilitation teams to ensure maximum client benefits. 

This presentation will demonstrate a variety of techniques that break down barriers, acknowledge and reveal an individual’s competence, and assist to reduce challenging communicative behaviours. Delegates will gain an improved understanding of the tools and skills that are necessary for individuals with ABI to gain control of their non-verbal voice through effective and persistent trans-disciplinary rehabilitation.     


References
Bondy, A, (2001). PECS: Potential benefits and risks. The Behavior Analyst Today,2. doi: 
10.1037/h0099924.
Carr, E.G., & Durand, V.M. (1985). Reducing behavior problems through functional communication 
training. Journal of Applied Behaviour Analysis, 2, 111-126. 
Durand, V.M. (1990). Severe behaviour problems: A functional communication training approach. New 
York: Gullford.

Rehabilitation Without Communication: Reducing challenging behaviours and enhancing client outcomes with functional communication