Neurological Practice - Seminar.

"Practical strategies for managing challenging behaviour following brain injury."
Blacker DD, McLaren S, Royal Hospital for Neuro-disability.


Challenging behaviour can be defined as: behaviours that seriously compromise a persons ability to engage and appropriately, productively and socially interact with their environment. 


Active challenging behaviours: 

• Overt and observational behaviours that can potentially cause harm to self or others (both pysical and verbal)

Passive challenging behaviours:

• An absence or lack of a particular type of behaviour. This could involve failing to express our wants, needs or feelings or communicating them in an indirect or apologetic way.

Inappropriate social behaviours:

• Sexualised behaviours.
• Disinhibition. 
•  Impulsive actions.
• Socially disruptive.

There is a need for OTs and those dealing with service users displaying challenging behaviour to have a good understanding of behaviours and need to react with a mix of proactive (long term) and reactive (short term) strategies.

Common strategies to manage challenging behaviours:

• Control and restraint (last resort). (Can cause social withdrawal and/or escalate the behaviour.)
• Sedation and medical intervention.
• Time out.
• Punishments.
• Breakaway techniques.
• Verbal de-escalation = negotiation, calming methods.
• Hierarchy  of techniques from less restrictive to control and restraint.
• Need to teach consequences of behaviour.
• Slow down movements.
• Think about how you sounds and what they are thinking.
• Options - what can be done?
• Plan for the situation.
• Change the environment - minimise negative stimulation, provide positives (meaningful and productive activities), provide structure and predictability.
• Change oursleves - Get to know your service users, build a rapport with them, use simple and clear language, provide personal space, alter your approach if necessary, don't offer things you can not give, get to know their behaviours and triggers.

De-escalation through communication:

More top tips:

• See the person not the problem.
• Look at the individual and their strengths.
• Be creative and flexible.
• Meaningful activities are a must!
• Provide explicit rewards.
• Help the individual to increase self esteem and control.
• Positive attitudes towards the patients.
• Task demands to consider: Activity as distraction, grade and adapt, re-direct individuals to positive/socially acceptable activities.
• Skills training to consider: Rebuild skills, teach more socially appropriate behaviour, coping strategies (anger and stress management etc.), alternative means of communication, use of props.

Remember:

Behaviour has a meaning!! Find it..


p.s. Sorry about the different colours in this post - I can't seem to get rid of them!!