Introduction
Deficits in verbal communication can negatively impact social relationships, and these deficits may cause additional harm in that people may be need to be removed from their comfortable and familiar environments. Green, Linsk and Pinkston (1986) conducted a study with two elderly gentlemen who had suffered strokes. Because of the inability to effectively communicate with their spouses both men were at risk of being placed in nursing facilities. The study investigated the effects of “reinforce[ing] positive and ignor[ing] undesired verbal responses (Green, et. al, p. 329). As speculated, both men were allowed to remain in their own homes and verbal communication dramatically improved. Both participants in the study were being cared for by their wives and were referred to the study by local hospitals. Mr. Orr, aged 67, suffered a stroke 3 months before the research study began. He lived in an upper class suburb with sufficient economic resources. Following the stroke, he often answered questions with inappropriate answers, and rarely engaged in “spontaneous or unprompted” conversation (Green, et. al, p. 330). Mr. Ford, aged 63, suffered a series of strokes for 15 years and resided in a small home in a low-income urban neighborhood. He was verbally abusive, particularly to his wife and often accused her of being unfaithful.
Design and Intervention
All sessions were conducted in the participants’ homes and were conducted by practitioners with graduates whose specialties were in gerontological behavior and rehabilitation. The independent variable (IV) in both studies was the methods used to reduce verbal deficits though methods differed in each case. The dependent variable (DV) was the frequency of problematic verbal communications. Both wives practice the intervention techniques with practitioners before administering treatment to their husbands. Once intervention techniques began to cause stabilization in proper verbal responses, the practitioners terminated their presence. Six months following this termination, a week-long follow-up study was conducted with participants.
For the Orrs, a single-study design of baseline, intervention, maintenance and 6-month follow-up was utilized. This design allowed for the evaluation of effectiveness of intervention across spontaneous and appropriate verbal responses. The IV was the application of contingent reinforcement which included touching, praising and smiling. Mrs. Orr was instructed to ask Mr. Orr a minimum of five questions during each hour of the day. The questions were to be set up to allow for yes-or-no responses as well as discussion-type responses. Mr. Orr was allotted up to one minute to respond; when answering appropriately, Mrs. Orr was instructed to touch the left side of his face.
The Fords’ single-study designed consisted of baseline, intervention, baseline, intervention and a 6-month follow-up which allowed for an assessment of the success of treatment on the paranoid and accusatory verbal communication. The IV for these participants was differential attention by instruction, demonstration and role-play. Mrs. Orr was instructed to ignore accusations of infidelity and abusive language and to leave the room if necessary. When appropriate language was utilized by Mr. Orr, Mrs. Orr was instructed to praise and/or touch him.
Results
The baseline for the Orrs was 67% verbally accuracy when prompted, averaging less than one appropriate response per hour. Once intervention was applied the verbal accuracy increased to 84% with an average of 2.5 appropriate responses per hour. During the maintenance phase of the study, accuracy was 82% and a mean of 2.4 appropriate responses hourly. This trend continued throughout the follow-up period. For the Fords, initial baseline data indicated inappropriate verbal communication lasted 72 minutes and average daily occurrences of 3.4 incidences. The first intervention period marked the same number of incidences; however the time decreased to 12 minutes. When intervention was ceased, the incidences lasted 108 minutes. Once intervention resumed, the mean time of incidences was significantly reduced to 19 minutes occurring at an average of one incident per day. These results were consistent throughout the follow-up phase.
Discussion and Conclusion This study clearly indicated that behavioral intervention is successful is increasing appropriate verbal responses in elderly patients. Instead of institutionalizing these men in nursing facilities, they were allowed to remain in their own homes with their spouses being trained by professionals to administer the treatment. Obviously, intervention needs to be tailored to the specific needs of the patient as each patient responds differently to intervention techniques. This study focused on stroke patients, but patients who may be verbally unresponsive or inappropriate due to other medical conditions may also benefit from these intervention techniques. Another important consideration is that such intervention may be more economically feasible for patients with lower incomes or those without insurance. Professionals are involved in the initial phases of the treatment, but the bulk is administered by family members or others in close relationships with the patient. Treatment occurs in one’s own home vice a facility that would require payment for use. Perhaps the main hindrance would be trial-and-error in seeking a treatment or intervention techniques that is successful to the individual payment. This could be further confounded by patients who are nonverbal or who could not appropriately verbalize needs. Finally, if a person does not have a strong support system to aid in intervention, then treatment may be further delayed or obstructed. Any obstacles to successful intervention may cause additional decay in social interaction and make any treatment less successful.

Reference

Green, Glenn R., Linsk, Nathan L., & Pinkston, Elsie M. (Winter 1986). Modification of Verbal Behavior of the Mentally Impaired Elderly by their Spouses. Journal of Applied Behavior Analysis, 19(4), 329-336. Retrieved from <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1308082/pdf/jaba00026-0020.pdf>