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Posts Tagged ‘adults with disabilities’

Under the Americans With Disabilities Act (2011) and Section 504 of the Rehabilitation Act (1973), a disability is a physical or mental disability that affects a major life activity. What is a “Major Life Activity”?

  • eating?
  • toileting?
  • walking?
  • playing with your family?

Until a disability affects you or one of your immediate family members, you have no idea how great of an impact it is. Try to imagine having to help someone eat 3 meals a day, plus snacks, day after day, after day. Words cannot describe how a “normal” family is affected. Eating out in restaurants? Sorry, we can’t do that. Going on a bike ride? Sorry, we can’t do that either.

Well, we couldn’t do that until just recently. You see, my (Missy) brother has a disability–well, let’s be honest–multiple disabilities (autism, cognitive disability, seizure disorder, mild cerebral palsy). Those disabilities affect many of his life activities as well as some of our family’s activities. Something as simple as riding a bike was too difficult for him. We tried those “special” bikes but since he cannot steer or use the braking system, bike riding just wasn’t possible for him.Plus, how could you get that bike on the bike rack? Sure, this tricycle/bicycle probably works for some people–it just didn’t work for us.

Enter, the Caboose Trailer Bike. This bike attaches to the back of an adult bike. Surely you have seen toddlers riding at the rear of bikes. This bike is similar except that it has two wheels at the back for added stability. The rider does not need to steer or brake. However, the rider has handle bars and fully functioning pedals to enable him or her to participate.

We ordered right from Pedal Cars and Retro dot com. The bike shipped in just a few days. It comes in a box and requires some assembly. However, once assembled, the only work that is required is attaching it prior to the ride. Well, ok…..it does require a bit of work to pedal depending on how much the rider weighs.

The trailer bike does not fit on our bike rack. It does, however, fit in the back of the SUV. So, all 5 of us, and our bikes, and the trailer fit snugly in one package.

Clearly, with my brother tagging along on family outings, we can never have a “normalĀ  life” but that won’t keep us from trying.

We are hanging out again this week over at Yeah Write. Hop on over there to visit other blogs where there are no winners just writers. Or you can head over to the challenge site and help pick out the winners on Thursday.
read to be read at yeahwrite.me

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Hi and welcome to What Works Wednesdays where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Readers really gravitated to our story on Monday about adults with disabilities so we thought we would share a success story about one of the adults we have served. Alwan’s adult service provider reached out to us because they needed help with his Self Injurious Behavior (SIB). Alwan hit his head about 2,000 times per month. The SIB was so severe that Alwan was required to wear a helmet all day. Alwan was blind in one eye from the SIB and he was developing cataracts in the other eye. Alwan was 28 years old and carried several diagnoses including profound mental retardation and autism.

Record Review

Because we “inherited” Alwan, we first completed an extensive record review. From the record review we learned that Alwan was heavily medicated in an attempt to decrease the SIB. Alwan had no formal communication system. Alwan had serious feeding issues and was on a strict puree diet. Additionally, he had a protocol for drinking liquids to prevent aspiration. Finally, Alwan had 1:1 staffing all day and 2:1 staffing when out in the community. Additionally, he was “pre-sedated” before all appointments and the staffing ratio on appointments was 4:1.

The record review also referenced a set amount of top spinning time. From the review we learned that Alwan enjoyed spinning tops, lids, etc. We did not, however, understand why this time was limited to only 30 minutes per day.

Functional Behavioral Assessment

The next step was to complete a functional behavioral assessment. We have defined, described, and given examples of these before. To get started, we created an ABC chart for the staff to complete when they observed these behaviors.

We also completed direct observations of Alwan. The observations revealed that Alwan was physically tugged, pulled, and directed all day long. Staff literally dragged him from place to place. Moreover, he had no choice about what to eat, what to drink, or even how to spend his time. Because he lacked communication, staff determined everything for him. The only thing Alwan could control was dropping to the floor and hitting himself in the head.

The observations also provided clarity about the issue around top spinning. When Alwan spent time spinning tops, he became very “worked up” and excitable. All of those behaviors led to an immediate increase of SIB. Essentially, he rocked, flicked the tops, watched them spin, laughed, and then proceeded to hit himself. However, if top spinning did not occur, head hitting was kept to a minimum.

We conducted interviews with staff to find out additional information about Alwan and his behavior. Staff revealed that Alwan really enjoyed walking to the park and riding in the van. Alwan also enjoyed taking a bath.

Many times, SIB is associated with pain, so we asked a few questions to help determine if underlying pain existed. We learned that Alwan had gastrointestinal (GI) issues that needed medical attention so we referred Alwan for a GI workup. Honestly, one bowel movement every 5 days is enough to make us hit our heads a few times.

Finally, we noticed that whenever Alwan was denied something that he wanted, he engaged in head hitting as if to say he was mad about being told no.

Intervention Priority: Communication

Our first concern for Alwan related to his need for a method of communication. We encouraged the provider to hire a speech and language pathologist to help design an appropriate communication system for him. Seriously, who graduates from a program at age 21 without a form of communication? We feel strongly that his IEP team neglected their duty to teach him important skills such as effective communication.

Intervention Priority: Leisure Skills and Reinforcement

We recognized early on that top spinning was a problem. First, it is not an appropriate leisure skill. Second, top spinning was directly correlated with head hitting. Thus, we wanted Alwan to learn new leisure skills. We also wanted Alwan to have more time doing the things he enjoys such as taking baths, going for van rides, and taking walks in the park. It is important for Alwan to have a meaningful day filled with things that he enjoys (and is capable) of doing.

Intervention Priority: Response Interruption and Redirection (RIRD)

Finally

Intervention Priority: Staff Training

We scheduled time for the staff to learn about why challenging behavior occurs. We also reviewed the current BIP and discussed our suggestions regarding changes to the BIP. We taught them how to increase the amount of time that Alwan spent doing things that we liked. We taught them how to interact with him in a way that decreased the amount of time their hands were tugging on his body and increased the amount of time they had positive physical interactions with him. We also taught staff how to implement RIRD.

Outcome

The team is continuing to follow up on Alwan’s GI care. They are making sure that he has regular bowel movements. They are increasing his opportunity for choice in what he eats and what he drinks. They are increasing access to preferred activities such as van rides and trips to the park.

The speech and language pathologist continues to work with staff on developing and implementing a formal mode of communication for Alwan. He is beginning to point to indicate what he wants and needs.

Staff are learning to attend to positive behaviors and to interrupt negative behaviors. They are also learning to interact with and enjoy Alwan.

Most importantly, Alwan has reduced his head hitting to only a few episodes each month! Isn’t it amazing how effective an assessment and function-based approach can be?

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