Operant conditioning for management of a noncompliant rehabilitation case after stroke

An operant conditioning model was used to design and implement a multidisciplinary intervention with a 53-year-old woman who was a difficult rehabilitation client after a cerebrovascular accident. She was depressed, noncompliant in learning ADL's refused to eat, and except for physical therapy (PT), was frequently absent from therapies or unmotivated if present. In a unified program, good performances in ADL's were rewarded with small privileges, increased eating was rewarded with extra PT, and attendance and good performance in therapies were rewarded with tokens exchangeable for weekend passes. Immediately after initiation of the program, there was a dramatic increase in appropriate behaviors.