Physical restraint procedures for managing challenging behaviours presented by mentally retarded adults and children.
Physical restraint can quickly stop severe behavior, but later studies give you safer, data-based ways to fade it and track harm.
01Research in Context
What this study did
The author read every paper he could find on holding people with intellectual disability to stop dangerous behavior.
He grouped the holds into three kinds: staff arms, chairs with straps, and devices the person puts on.
The review asked two questions: why does holding work, and what can go wrong?
What they found
Holding usually lowers hitting, kicking, or head-banging while it is in place.
No one knows exactly why. Pain relief, escape, or just fatigue could all play a part.
Both staff and clients can get hurt. Bruises, bites, and long-term trauma are real risks.
How this fits with other research
Jarrold et al. (1994) had already shown you can fade holds safely by teaching the person to ask for breaks instead. Their single-case design gave a clear how-to, something the 1996 review said was missing.
Nasr et al. (2000) later asked staff and youths to rate holds. Chair holds won the acceptability vote, giving the first stakeholder data the review called for.
Scheithauer et al. (2015) cracked one black box: when clients wrap themselves in clothing, the hold is rewarded because it stops their own self-hits. Their functional analysis supplies the mechanism the 1996 paper could only guess at.
Hardesty et al. (2025) now treat staff injuries like behavior data. Their safety-monitoring forms turn the review’s injury warning into a daily graph you can actually track.
Why it matters
You now have tools the review said were missing. Pair any hold with a fade plan like Jarrold et al. (1994), track staff injuries like Hardesty et al. (2025), and run a quick functional analysis if self-restraint shows up (Mindy et al., 2015). The papers knit together into a safer, data-driven restraint protocol you can start Monday.
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02At a glance
03Original abstract
This paper reviews the published research literature on the use of physical restraint with mentally retarded adults and children. Research on three types of restraint is included. One type involves one or more person(s) holding another. A second method is where a mechanical device is fitted to limit movement or reduce injury. The third type is where the person voluntarily applies a personal or mechanical restraint. The following conclusions emerged: (a) there are numerous processes which contribute to the outcomes associated with restraint, and these are poorly understood; (b) different processes mediate the outcomes for contingent and noncontingent restraint; (c) both noncontingent and contingent restraint can result in long-term reductions in target behaviours, especially when fading procedures are employed (noncontingent restraint) and where staff or carers are involved in the treatment plan (contingent restraint); (d) self-restraint seems to be maintained by the reinforcing effects of the restraint procedure or by escape from the aversive consequences of self-injury; (e) there are (negative) reinforcing consequences for staff who use restraint procedures in service settings; (f) and both staff and clients risk injury, especially from emergency or unplanned restraint.
Research in developmental disabilities, 1996 · doi:10.1016/0891-4222(95)00036-4