Date of Award


Document Type

Scholarly Project

Degree Name

Master of Occupational Therapy (MOT)


Occupational Therapy

First Advisor

Anne M. Haskins


Behavior Control -- methods; Brain Injuries -- complications; Health Personnel -- education


An estimated 1.7 million individuals sustain a brain injury each year (Centers for Disease Control & Prevention, 2010). Some behaviors associated with brain injuries include: decreased academic performance, severe aggression, self-injurious behavior, and suicidal and homicidal ideation (Finfgeld-Connet, 2009; Pace, Dunn, Luiselli, Cochran, & Skowron, 2005). The aforementioned behaviors pose a risk to the well-being of patients, therapists, healthcare providers and caregivers. The purpose of this scholarly project was to explore current methods used to minimize dangerous behavioral clients and ultimately provide a teaching module of antecedent techniques - a form of intervention used in order to reduce a behavior (Pace et al., 2005) - to therapists, care givers, healthcare workers, and any other persons who interact on a consistent level with brain injured individuals.

A thorough literature review of antecedent interventions used with individuals who have sustained a brain injury was conducted with a focus on young and middle aged adults using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, and the Academic Search Premier databases. Some key terminology used during the literature search included: antecedent, brain injury, occupational therapy, and behavioral management. It was discovered that maladaptive behaviors of those with traumatic brain injuries (TBI) limit their participation in daily activities. Often times, healthcare workers, therapists, and caregivers withstand the worst of aggressive behaviors brought on through symptomology of a brain injury. While literary authors thoroughly described the behaviors and limitations that may occur following a brain injury, a paucity of educational workshops to educate professionals and caregivers was noted. Guided by the Model of Human Occupation, this educational workshop addresses the roles, habits, and routines of individuals with TBIs. Constructivism and Social Learning Theory were used to guide the product creation. The culmination of the literature review resulted in the creation of a teaching module entitled Antecedent Techniques Used to Regulate Aggressive Behavior in Patients with Brain Injuries: A Teaching Module.

Antecedent Techniques Used to Regulate Aggressive Behavior in Patients with Brain Injuries: A Teaching Module is a workshop designed to provide healthcare workers with greater understanding and application of antecedent techniques that can be used in conjunction with other interventions for individuals with TBIs who exhibit aggressive behaviors. The workshop includes a two-hour literature review on brain injury followed by a one-hour implementation session to integrate and rehearse strategies learned. Examples of antecedent techniques in this scholarly project include: desensitization, creating a just-right challenge, environmental modifications, patient-centered care, participation in meaningful activities, assisting the individual in management of difficult situations, and normalization of behaviors (Feeney et al., 2001 & Finfgeld-Connet, 2009; Pace et al., 2005).

Approximately 60% of individuals with a mild brain injury exhibit aggressive tendencies towards themselves or others (Rao et al., 2009). Through the use of these antecedent intervention techniques, we anticipate healthcare workers will ultimately be able to decrease problematic behaviors, increase therapeutic gains, and improve overall safety of people with traumatic brain injuries and others who are involved in their lives and occupations.