Presented at the XVth Biennial ISSBD (International Society for Behaviorural Developement) Meeting, Bern(Switzerland July 1-4

ABSTRACT

Patient X., 51 years, received nonverbal guided tactual interaction therapy from 1 to 16 months after having suffered a head trauma. Patient Y., 24 years, went through three periods: from 39 to 60 months after head trauma, he received nonverbal guided tactual interaction therapy; from 60 to 89 months, visual-auditory training; from 89 to 101 months, nonverbal guided tactual interaction therapy. Event performances of both patients were recorded on videotapes and analyzed. Patient X. improved over time on frequent events, first in understanding and continuing some actions of the events when tactual or visual information was provided. At 16 months of therapy he was able to solve daily events successfully step-by-step when visual information about the goal was provided. Patient Y. improved during the first period from understanding short daily habit events with tactual information in familiar situations (hospital) to understanding daily events of a more complex kind, and continuing some actions when tactual information was provided. After 29 months of visual-auditory training during the second period, he had regressed: he understood short daily habit events only when tactual information was provided, no actions were continued. After 7 months of nonverbal guided tactual interaction intervention he improved on comprehension and continuation in events with a network of sequences of actions and a new content. It appears that nonverbal guided tactual interaction intervention may be more adequate to improve daily interaction in brain-damaged patients than visual auditory training programs.

PURPOSE

To gain knowledge about changes in behavior in relation to different therapeutic interventions at different periods of recovery.

ASSUMPTIONS

Tactual interaction in daily life can be regarded as root for development and also for progress even in patients with severe brain-damage, and with late beginning of guided tactual interaction intervention in daily life activities.

METHOD

1.Subjects

• Patient X., 51 years old, severe head trauma. For 16 months, X. received guided tactual interaction therapy, beginning at three weeks after occurrence of brain damage. 
• Patient Y., 24 years, old, severe head trauma. First period of guided tactual interaction intervention for 21 months began at 39 months after occurrence of accident-, interruption for 29 months with various visual-auditory training procedures, followed by a second period of guided tactual interaction intervention during one year.

2.Hypotheses

• Patients receiving guided tactual interaction intervention continuously will improve daily life interaction in a regular way: first at home, then in familiar surroundings; first when provided with tactual information, followed by visual 1 verbal information. When therapy is discontinued, regression occurs.
• Guided tactual interaction intervention is followed by improvement even when it starts years after the occurrence of brain damage.

3.Observations

• Patient X's criteria of selected events occurring frequently, presenting a network of sequences, relevant and irrelevant stimuli present in the field of action. Evaluation times were at 6 months after occurrence of brain damage, at 12 and at 16 months.
• Patient Y.'s criteria: one of the events was a habit, 3 were frequently occurring, one was new for four events guided tactual information was provided, for one event visual. Evaluation times were: for the first period, at the beginning (39 months after the occurrence of brain damage), then at 9 months later. For the second period, at the beginning and 7 months later.

4.Analyses

Video recorded and selected events were analyzed by at least three different observers according to-

a. Content of the event:

b. Structure of the event.

• One goal with a simple sequence of actions.
• Main-goal and sub-goals with a network of sequences of actions.

c. Situational features of the event:

• Familiarity of the surroundings: since both patients were in a rehabilitation clinic, the surroundings were judged as 'familiar', in contrast to 'at home' (most familiar) .
• Field of activity: stimuli relevant for the event, or both, irrelevant and relevant stimuli were present; field can change or not.

d. Information available for the beginning of the event-.

• Guided 1 tactual
• Visual

e. Comprehension- a specific pattern of posture 1 behavior is interpreted as comprehension: stays calm when working, attentive, no jerks ...

f. Continuation of action: a patient is guided, then continues the action without being guided.

g. Production: patients are not guided; no verbal command is given, they begin the sequence of actions of an event spontaneously and precede step-by step.

h. Reaches goal successfully.

RESULTS AND CONCLUSIONS

Results support the hypotheses:

1 . Results of patient X (see Table 1) showed improvement for events under the described conditions, presenting a network of sequences, irrelevant and relevant stimuli present-

a. Within a specific information condition.

• When receiving guided 1 tactual information: at the first event, comprehension was restricted to 'no change of field of activity'; at the fourth event, changes were now possible;
• When visual information was provided, improvement was observable from no comprehension of event at the second event, to comprehension but no changes of field of activity and not reaching goal at the third event and production and reaching goal at the fifth event.

b. Comparison between different kinds of information conditions:

• For events 1 and 2: comprehension was observable for guided tactual information, but not for visual information.
• Events 3 and 4: comprehension, continuation and changes of field of activity were observable for guided tactual information; comprehension, but no continuation and no changes of field of activity were observable for visual information. 
• For event, 5: for visual information spontaneous production step-by-step was observed.

Conclusions for patient X

• For each information condition improvement was observable in a regular sequence: from comprehension with no changes in field of activity to comprehension and changes in field of activity; and to production at last.
• Improvement was always first observable when guided tactual information was provided, and later when visual information was provided.

2. Results of patient Y. (see Table 2) 

a. Results of the first period. Guided tactual intervention began 39 months after accident. Patient Y. improved for events under the described conditions and when receiving guided/tactual information. See events 1, 2 and 3.

• He improved on comprehension and continuation of actions from events with short sequences of actions to events with a network of sequences of actions (structure of event).
• Comprehension was first observable when only relevant stimuli were present, later comprehension appeared when irrelevant and relevant stimuli were present.
• First no change in field of activity of actions was required, later changes were possible.
• He never showed comprehension when visual information was provided, even when he was involved in habit events.

Conclusion one of patient Y.

Improvement was observable when patient received guided tactual intervention even after several years since occurrence of brain damage.

b. Results of the second period of guided tactual intervention.

• Readmission: no comprehension was observable even when patient received guided tactual information with only the relevant stimuli present, and field of activity not changed (see event 4).
• After 7 months of guided tactual intervention, patient Y. functioned again when receiving guided tactual information as described at the end of the first period, even in events with a new content (see event 5).

Conclusion two of patient Y.

When guided tactual intervention was discontinued as the patient functioned still on a low level, the patient was regressing. However, improvement was still possible when he received again guided tactual intervention in daily life activities.

Addresses of the authors:

Nielsen, Kand Mohr, S. Therapiezentrum Burgau Dr.Friedl-Strasse 1 D - 89331 Burgau

Co-Covenors :

Dr.F.Affolter Dr.W.Bischofberger

Table 1: Longitudinal observations of nonverbal tactual interaction in daily life - Patient X