Application of a token economy with a non-compliant closed head-injured male.

This study examined the application of several principles and procedures of operant conditioning in the rehabilitation of a closed head-injured 18-year-old male. The patient exhibited frequent and extreme verbal outbursts during therapy sessions, and he did not comply with rehabilitation exercises. After a goal-setting plus extinction procedure failed to improve compliance or to decrease disruptive vocalizations a contingent token reinforcement intervention was implemented to increase compliance with therapeutic activities. Frequency of disruptive vocalizations was measured as a covarying behaviour. The intervention was evaluated using a single-case experimental design. Results showed that both compliance with therapeutic activities and frequency of disruptive vocalizations changed as a function of contingent token reinforcement. The effect was replicated across three settings. This study demonstrates the generality of behavioural principles and procedures with closed head-injured populations in an acute rehabilitation setting. The functional equivalence of topographically dissimilar behaviours and the situation-specific control of behaviour is discussed.