Gorski Jo Anne, Slifer Keith J, Townsend Vanessa, Kelly-Suttka Jennifer, Amari Adrianna
The Kennedy Krieger Institute, Maryland, USA.
Pediatr Rehabil. 2005 Jul-Sep;8(3):187-98. doi: 10.1080/13638490400021438.
To demonstrate the efficacy of using differential reinforcement to treat non-compliance in adolescents with spinal cord injury.
A case series design was used to examine three adolescents (aged 14-16 years) with tetraplegia who received multi-disciplinary rehabilitation treatment and a behavioural contract programme during an in-patient hospital admission. Assessment included collecting data on each patient's weekly percentage of compliance with all rehabilitation goals, weekly percentage of negative affect observed in therapy sessions and scores on a measure of mobility in physical therapy.
Compliance with rehabilitation demands improved from a baseline of 20-65% to 80% or greater after the patients received differential reinforcement for participating in the rehabilitation regimen. Patients exhibited less anger, sadness and frustration during therapy sessions once contracts were started.
The adolescents demonstrated greater compliance after the implementation of a behavioural contract. Future studies should identify the specific variables that affect psychological adjustment and predict 'readiness' to participate in rehabilitation.
证明使用差别强化疗法治疗脊髓损伤青少年不依从行为的疗效。
采用病例系列设计，对三名患有四肢瘫痪的青少年（年龄在14至16岁之间）进行研究，他们在住院期间接受了多学科康复治疗和行为契约计划。评估内容包括收集每位患者每周对所有康复目标的依从百分比数据、治疗期间观察到的每周消极情绪百分比以及物理治疗中的活动能力测量得分。
在患者因参与康复方案而接受差别强化后，对康复要求的依从性从基线的20%至65%提高到了80%或更高。一旦开始实施契约，患者在治疗期间表现出的愤怒、悲伤和沮丧情绪减少。
实施行为契约后，青少年表现出了更高的依从性。未来的研究应确定影响心理调适并预测参与康复“准备度”的具体变量。
