Restraint fading and alternate management strategies to treat a man with Lesch-Nyhan syndrome over a 2 year period

In this study the variables maintaining self-injury and the use of wrist restraints in a man with Lesch–Nyhan Syndrome were identified through a pre-treatment functional assessment. In phase I, the client's self-injury and use of wrist restraints were treated by his participation in a relaxation training class and substituting his wrist restraints with a hockey-type head helmet in order to reduce self-injury and dependency on the use of wrist restraints and increase functional use of his hands. In phase II, a restraint fading procedure was implemented. This consisted of removing his restraints twice daily for 20 min and engaging him in hand over hand training. This was done in order to systematically reduce the amount of time the subject spent in restraint. In phase III, generalization was implemented across settings including work and home and across different staff persons. In phase IV, skills shaping was used to train the subject to use his hands to engage in and improve his activities of daily living. The results demonstrate a decrease in restraint use and an increase in adaptive and social experiences and reductions in challenging behaviors over a 26 month period.