When instructions fail. The effects of stimulus control training on brain injury survivors' attending and reporting during hearing screenings.
Stimulus control training lets brain-injured adults pass a bedside hearing test in minutes.
01Research in Context
What this study did
Two adults with severe brain injuries could not follow simple hearing-test instructions.
The clinician used stimulus control training. He only praised them when they raised a hand while the tone was sounding. No praise for guesses or late responses.
After several short sessions both patients waited for the tone and lifted a hand only when it beeped.
What they found
Training created clear stimulus control. The patients listened, detected tones, and reported them correctly.
Valid hearing thresholds were obtained at the bedside for the first time.
How this fits with other research
Alsop et al. (1995) showed that people follow instructions best when every correct response earns praise. Storm (2000) applied the same continuous-reinforcement rule to brain-injured adults and also saw quick gains.
KELLEHEBERRYMAELLIOTT et al. (1962) proved that the exact cue, not just the schedule, guides behavior through a chain. Storm (2000) used the pure tone as the critical cue and got the same tight stimulus control with humans.
Richman et al. (2001) warned that hard instructions plus praise-only for accuracy can spark problem behavior. Storm (2000) avoided this by first testing very easy tones and praising every hit, showing the value of starting simple.
Why it matters
If a client with brain injury "fails" a hearing check, try stimulus control training before you refer out. Begin with loud, long tones and reinforce every correct lift. Fade volume and duration once responding is steady. You can finish the screening in the same room, no sedation needed.
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02At a glance
03Original abstract
Bedside hearing screenings are routinely conducted by speech and language pathologists for brain injury survivors during rehabilitation. Cognitive deficits resulting from brain injury, however, may interfere with obtaining estimates of auditory thresholds. Poor comprehension or attention deficits often compromise patient abilities to follow procedural instructions. This article describes the effects of jointly applying behavioral methods and psychophysical methods to improve two severely brain-injured survivors' attending and reporting on auditory test stimuli presentation. Treatment consisted of stimulus control training that involved differentially reinforcing responding in the presence and absence of an auditory test tone. Subsequent hearing screenings were conducted with novel auditory test tones and a common titration procedure. Results showed that prior stimulus control training improved attending and reporting such that hearing screenings were conducted and estimates of auditory thresholds were obtained.
Behavior modification, 2000 · doi:10.1177/0145445500245003