Cueing and logical problem solving in brain trauma rehabilitation: frequency patterns in clinician and patient behaviors

Frequencies (count per minute) of patient and therapist behaviors during rehabilitation sessions after traumatic brain injury were tracked in order to evaluate an intervention curriculum and the effects of cueing. Frequencies of correct solutions to logical problems and other verbal tasks during speech-language treatments were measured for an adult male with memory impairments and impulsivity who underwent inpatient rehabilitation 14 months after severe traumatic brain injury. Daily frequency of cues by the clinician during the patient's logic exercises also was measured. These behaviors were recorded each treatment session for 14 weeks. Simple plots of the behavior frequencies were maintained by the clinician on standardized semi-log graph paper. The patient's performance in solving logical problems improved measurably but gradually. Day-to-day predictability of patient performance was seen, as was predictability in cueing by the clinician. Celerations (trends measured as changes in count per minute per week) in the clinician's cueing were inversely related to celerations in the patient's logical problem solving, a pattern evident through multiple reversals. Data from other verbal performance tasks showed no general improvement, nor any pattern of variability paralleling the data on logical problem solving. The data suggest that, for clients with brain trauma, routine continuous measurement of frequencies of behavior may facilitate clinical application of experimental analysis and intervention techniques to improve performance. Measuring the frequency of clinician behavior can help identify the events and conditions that control aspects of patient behavior. Frequency measurement has also been used in physical therapy and occupational therapy, and it is suggested that this method be examined as a common data language for use across rehabilitation disciplines.