1/2. Ethical issues involved in the implementation of a differential reinforcement of inappropriate behaviour programme for the treatment of social isolation and ritualistic behaviour in an individual with intellectual disabilities.The present case study describes an adult male with a 28-year history of institutional care underpinned by a moderate intellectual disability (ID), and ritualistic behaviour congruent with features of autism or obsessive-compulsive disorder. The subject's ID was recognized early in life and he was provided with a special educational placement at 6 years of age, although his increasingly disturbed behaviour had resulted in several psychiatric admissions by early adolescence, and by the age of 20, his presentation necessitated long-term secure psychiatric care. The present report describes the application and ethical issues pertaining to a differential reinforcement of inappropriate behaviour (DRI) programme for the reduction of ritualistic behaviour and social isolation, the latter being a direct consequence of the former, one year after the subject was admitted to a medium-secure assessment and treatment residential facility. The results suggest that, although the treatment was successful in targeting ritualization and reducing social isolation, ethical concerns extended to care staff concerns about the reinforcer adopted for the programme and the lack of informed consent from the subject. The former resulted in inconsistent application of the programme and its eventual termination. A follow-up assessment of the subject's extent of social isolation and ritualistic behaviour suggested a return to a pre-DRI level of morbidity. Limitations and suggestions for the future treatment of such cases are outlined.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
2/2. Variability in the perceptual and physiological features of dysarthria following severe closed head injury: an examination of five cases.The perceptual and physiological features of the dysarthric speech of five severely closed-head-injured (CHI) subjects were examined in a case-by-case analysis. The five male CHI subjects included in the study were selected to reflect the range of severity and types of dysarthria evident in the CHI population. The perceptual profiles of each subject consisted of the findings of a perceptual speech analysis, the Frenchay dysarthria Assessment (FDA) and the Assessment of the Intelligibility of Dysarthric Speakers (ASSIDS). The subjects' physiological profiles included the results of instrumental assessments of the respiratory, laryngeal, velopharyngeal and articulatory subsystems of the speech-production mechanism. The case studies highlighted the variability among the individual subjects with respect to the location, physiological nature, and severity of impairment in their speech-production mechanisms. In addition, the interdependence of the various speech subsystems in determining speech outcome, the presence of differential subsystem impairment in dysarthria following CHI, and the varied therapeutic requirements of the individual subjects were identified. Clinically, the case studies highlighted the importance of developing individual treatment programmes based on comprehensive perceptual and physiological evaluations of the speech mechanism in each CHI subject with dysarthric speech.- - - - - - - - - - ranking = 0.14285714285714keywords = programme (Clic here for more details about this article) |