title: Behavioural treatment of non-compliance in adolescents with newly acquired spinal cord injuries.
abstract: OBJECTIVE
  To demonstrate the efficacy of using differential reinforcement to treat non-compliance in adolescents with spinal cord injury.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Kennedy Krieger Institute, Maryland, USA. joanneg@blythedale.org
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Gorski
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Slifer
authors.forename: Vanessa
authors.initials: V
authors.lastname: Townsend
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kelly-Suttka
authors.forename: Adrianna
authors.initials: A
authors.lastname: Amari
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000786:Anger; D001007:Anxiety / Q000523:psychology; D001521:Behavior Therapy; D002574:Cervical Vertebrae / Q000293:injuries; D032982:Contracts; D003863:Depression / Q000523:psychology; D005260:Female; D005639:Frustration; D006040:Goals; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology; D010343:Patient Admission; D010349:Patient Compliance; D010358:Patient Participation; D026741:Physical Therapy Modalities; D011782:Quadriplegia / Q000523:psychology / Q000534:rehabilitation*; D012054:Reinforcement, Psychology; D012917:Social Adjustment; D013119:Spinal Cord Injuries / Q000523:psychology / Q000534:rehabilitation*; D016312:Treatment Refusal / Q000523:psychology*