Single case methodology in neurobehavioural rehabilitation: Preliminary findings on biofeedback in the treatment of challenging behaviour

Abstract

The use of single-case methodology (SCM) in brain injury rehabilitation is described and contrasted with other methodologies. SCM is optimal when attempting to meet highly individual presentations or to trial innovative solutions. Portable biofeedback is a potentially effective means of helping persons with brain injury to recognise and regulate emotional states. Emotional dysregulation, associated with disinhibition on tests of executive function, is hypothesised to underpin aggressive challenging behaviour and may be amenable to feedback on heart rate variability, a marker for stress. Two case studies of a novel biofeedback intervention, emWave2, to address aggression directed towards the self and towards others are presented. Data from two A-B designs were analysed using the non-overlap all pairs (NAP) statistical method. Clinical significance of outcome is reported in both cases but only Case 2 reached statistical significance. The discussion highlights limitations of the methodology. Results are discussed in relation to the device helping participants differentiate the physiological state associated with stress. The future application of wearable physiological sensing and feedback systems is explored.