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Brain Injury & Behavioral Dyscontrol: Dialogue, Skills & Consequences

presented by Robert Karol, Ph.D., LP, ABPP-RP, CBIST

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Disclosure Statement:

Robert Karol receives compensation from MedBridge for this course. Robert Karol receives royalties for his books from the following organizations: Oxford University Press, CRC Press and Lash and Associates Publishing.

Non-Financial: Robert Karol is on the Board of Directors – United States Brain Injury Alliance.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Behavioral dyscontrol refers to manifestations of inappropriate conduct. It includes noncompliance/nonadherence, physical aggression, verbal aggression/threats, sexual inappropriateness, poor safety/judgment, elopement, wandering, making demands/being manipulative, hoarding, social withdrawal, self-injurious behavior, suicidal ideation/behavior, somatic complaints, unawareness of deficits, hallucinations/delusions, etc.

Behavioral dyscontrol after brain injury can be treated. There are three basic intervention methods: therapeutic discussion, skill building, and contingencies. However, it is crucial that these be applied with an understanding of how to adjust them for the needs of people with brain injury. The goal of this course is to delineate the nature of each intervention, the pitfalls of its use in therapeutic treatment of those with brain injury, and how to adjust each to be most successful. This course is Part 3 of a four-part series of courses on behavioral dyscontrol following brain injury.

Meet Your Instructor

Robert Karol, Ph.D., LP, ABPP-RP, CBIST

Dr. Karol is President of a group private practice, Karol Neuropsychological Services & Consulting, in Minneapolis, that specializes in counseling for persons with brain injury and other disabilities, neuropsychological and rehabilitation evaluations, program development consultation for organizations, workshops & staff training, and case consultation for providers, insurers, and attorneys. Dr. Karol has also recently served…

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Chapters & Learning Objectives

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1. Therapeutic Discussion

Therapeutic discussion, or counseling, is one of the major interventions for behavioral dyscontrol. It addresses people’s views of their disabilities and provides insight into coping with them so as to avoid behavioral dyscontrol. However, it must be adjusted for the needs of people with brain injury. In fact, many of the adjustments apply to any communication between professionals and people with brain injury (e.g., nurse to patient). The goal of this chapter is to explain how to conduct therapeutic discussion with persons with brain injury.

2. Skill Building

Skill building is often used to treat behavioral dyscontrol. Skill building attempts to provide the person with alternative methods for responding to situations in order to avoid behavioral dyscontrol. However, how one teaches skills can be crucial. The goal of this chapter is to explain the concept behind skill building and to discuss how to best accomplish it.

3. Consequences

Behavioral dyscontrol can be treated with the use of consequences. Consequences—rewards or punishments—following a behavior lead people to change their behavior next time by increasing behavior that leads to rewards or decreasing behavior that leads to punishment. However, the use of consequences is complex and must be undertaken with care, particularly when used in treating persons with brain injury. The goal of this chapter is to review the application of consequences and their strengths and pitfalls.

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