The Independent Living Scale (ILS) was developed in a post-acute traumatic brain injury (TBI) rehabilitation facility over a 15-year period to assess three main areas: (1) activities of daily living, (2) behaviour, and (3) initiation. The purpose of this study was to examine the psychometric properties of the ILS, including test--retest stability, construct validity, and statistical fit. Statistical analysis was completed on all weekly scores between the years 1986-1995 (n = 5250). A previous study showed ILS inter-rater reliability to be 0.85 and convergent validity 0.82--0.87. This study demonstrated a test--retest stability of 0.72, the Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0.94 (marvelous), and a Bartlett Test of Sphericity result of 'scale items independent'. The ILS was shown to have good construct validity, inter-rater reliability, internal consistency, instrument stability, and convergent validity.

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This study provided further substantiation of the neuropsychological spectrum conceptualization (Templer, Campodonico, Trent, Spencer, & Hartlage, to appear; Templer, Spencer, & Hartlage, 1993; Templer, Campodonico, Trent, & Spencer, 1991). Two hundred and two traumatic brain injury patients were administered the Wechsler Adult Intelligence Scale-Revised, the Luria-Nebraska Neuropsychological Battery, the Wisconsin Card Sorting Test, the Booklet Category Test, and Trails A and B. The correlations between neuropsychological and intellectual tests were significantly lower than the correlations within intelligence tests and within neuropsychological tests. Neuropsychological tests predicted outcome better than intelligence tests. This was interpreted in terms of outcome for severely brain-damaged patients being more dependent upon basic neuropsychological functioning than on abstract thinking ability.

Many different intervention programmes for reducing undesirable behaviour with people with traumatic brain injury (TBI) have been investigated in recent years. The purpose of this study was to examine the potential of using noncontingent reinforcement (NCR) in combination with contingent restraint to reduce severe behaviour. The subject (E.L.) was a 40-year-old male with TBI admitted to a rehabilitation long-term care programme. E.L. had a history of physical aggression (PA) and self-injurious behaviour (SIB). Assessment conditions included a descriptive analysis, response scatterplot and Self-Injury Trauma (SIT) Scale. Attention was identified as the maintaining positive reinforcement for PA and SIB. Treatment conditions were compared using a reversal (ABAB) design. Attention (NCR) was delivered on a fixed-time schedule that was not dependent on the subject's behaviour. Contingent restraint was applied when E.L. exhibited PA or SIB that was dangerous to himself or others. During treatment, PA occurred over 4 times less often and SIB over 2.5 times less often. Results demonstrated that PA and SIB were sensitive to NCR. NCR can be an effective procedure for reducing severe behaviour maintained by socially-mediated positive reinforcement.

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