Gordon Muir Giles

Gordon Muir Giles is a professor at Samuel Merritt University in Oakland California and a Fellow of the American Occupational Therapy Association. He is best known for his work in rehabilitation following traumatic brain injury (TBI) and other forms of acquired neurological impairment. His two major contribution to TBI rehabilitation are the Neurofunctional Approach to brain injury rehabilitation (with J. Clark-Wilson) and non-aversive treatment of persons with neurobehavioral disability and behaviour disorder (sometimes referred to as relational therapy).[1]

Gordon Muir Giles
Born4 July 1957
Woking, Surrey UK

Education and early career

Giles received his undergraduate degree from the University of Warwick, UK and his PhD from the California School of Professional Psychology, USA. He was trained in rehabilitation of persons with TBI in the early 1980s at the Kemsley Unit of St Andrew's Hospital, UK. The Kemsley unit was the first program to use applied behavioural analysis principles to rehabilitation of persons with behaviour disorder after TBI, and his publications from this period are straightforward applications of behavioural methods to TBI.[2][3] Noteworthy however is the first application of errorless learning principles to this population (though the term errorless learning was not used).[4]

Neurofunctional approach

A full description of the Neurofunctional approach was published in 1993.[5] Although highly influenced by applied behavioural analysis, it incorporates social learning principles and considers the social and emotional consequences of the injury in rehabilitation. The Neurofunctional approach is designed for individuals who are unlikely to develop self-care or community independence skills spontaneously. Treatment focuses on "learning by doing." In the Neurofunctional approach this "doing" is structured using an errorless learning approach and repetition to develop "internalized performance models" intended to automatically guide future performance. Practice of the actual task in a prescribed format is intended to reduce the executive demands of the activity. Practiced tasks are expected to improve, and as the individual develops competencies there may be effects on his or her goal-states and self-esteem that will further enhance performance (i.e., a bottom-up approach).[6][7] A randomised controlled trial (RCT) reported by Vanderploeg and co-workers,[8][9][10] indicated that the Neurofunctional approach is as effective as an established form of cognitive rehabilitation when added to standard care in assisting individuals with TBI achieve return to work/school or independent living. Additionally, small scale studies of the Neurofunctional approach have suggested that it is the only approach demonstrated to improve functional skills in persons many years post TBI.[11][12] In the professional language of occupational therapists the Neurofunctional Approach is described as a frame of reference, and an occupation based approach.

Applied behaviour analysis

More recently, Gordon Muir Giles has been reporting on interventions for persons with acquired neurological impairments and behaviour disorder. Beginning in the 1980s applied behaviour analysis principles were introduced for use with persons with TBI. By the late 1990s however it was recognised that up to a third of persons with TBI and behaviour disorder were unable to make use of standard behavioural interventions.[13][14][15] Non-aversive approaches to behaviour disorder after TBI are consistent with concepts in psychiatric rehabilitation and positive behavioural supports in work with persons with mental retardation but were developed independently from them. The interventions stress a philosophy of normalisation, respect, non-confrontation, positive engagement, support, and functional and behavioural skill development. The approach is based on the observation that much of the behavioural disregulation is hostile/irritable aggression and not instrumental in nature. The interventions attempt to reduce environmental stressors and instigations to aggression and to use inclusion and positive engagement to reduce the frequency of aggressive behaviour. Evidence is currently limited to small-scale proof of concept designs and the approaches have not been subjected to randomised controlled investigations.[16][17]

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References
  1. Giles, G. M., & Manchester, D. (2006). Two approaches to behavior disorder after traumatic brain injury. Journal of Head Trauma Rehabilitation, 21(2), 168–178.
  2. Giles, G. M., & Clark-Wilson, J. (1988). The use of behavioral techniques in functional skills training after severe brain injury. The American Journal of Occupational Therapy, 42, 658–665.
  3. Giles, G. M., & Shore, M. (1989). A rapid method for teaching severely brain-injured adults to wash and dress. Archives of Physical Medicine and Rehabilitation, 70, 156–158.
  4. Giles, G. M., & Clark-Wilson, J. (1988). The use of behavioral techniques in functional skills training after severe brain injury. The American Journal of Occupational Therapy, 42, 658–665.
  5. Giles, G. M., & Clark-Wilson, J. (Eds.). (1993). Brain injury rehabilitation: A neurofunctional approach. San Diego: Singular.
  6. Giles, G. M., Ridley, J., Dill, A., & Frye, S. (1997). A consecutive series of brain injured adults treated with a washing and dressing retraining program. American Journal of Occupational Therapy, 51, 256–266.
  7. Parish, L., & Oddy, M. (2007). Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury. Neuropsychological Rehabilitation, 17(2), 230–243.
  8. Giles, G. M. (2009). Maximizing TBI rehabilitation outcomes with targeted interventions. Archives of Physical Medicine and Rehabilitation, 90(3), 530.
  9. Vanderploeg, R. D., Collins, R. C., Sigford, B. J., Date, E. S., Schwab, K., Warden, D., et al. (2006). Practical and theoretical considerations in designing rehabilitation trials: The DVBIC cognitive-didactic versus functional-experiential treatment study experience. Journal of Head Trauma Rehabilitation, 21(2), 179–193.
  10. Vanderploeg, R. D., Schwab, K., Walker, W. C., Fraser, J. A., Sigford, B. J., Date, E. S., et al. (2008). Rehabilitation of traumatic brain injury in active duty military personnel and veterans: Defense and veterans brain injury center randomized controlled trial of two rehabilitation approaches. Archives of Physical Medicine and Rehabilitation, 89, 2227–2238.
  11. Giles, G. M., Ridley, J., Dill, A., & Frye, S. (1997). A consecutive series of brain injured adults treated with a washing and dressing retraining program. American Journal of Occupational Therapy, 51, 256–266.
  12. Parish, L., & Oddy, M. (2007). Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury. Neuropsychological Rehabilitation, 17(2), 230–243.
  13. Eames, P. (1992). Hysteria following brain injury. Journal of Neurology, Neurosurgery, and Psychiatry, 55, 1046–1053.
  14. Eames, P., Cotterill, G., Kneale, T. A., Storrar, A. L., & Yeomans, P. (1995). Outcome of intensive rehabilitation after severe brain injury. Brain Injury, 10(9), 631–650.
  15. Giles & Manchester, 2006
  16. Giles, G. M., Wager, J., Fong, L., & Waraich, B. S. (2005). Twenty-month effectiveness of a non-aversive, long-term, low cost programme for persons with persisting neurobehavioural disability. Brain Injury, 19(10), 753–764.
  17. Giles, G. M., Wilson, J., & Dailey, W. (2009). Non-aversive treatment of repetitive absconding behaviour in clients with severe neuropsychiatric disorders. Neuropsychological Rehabilitation, 19(1), 28–40.

Other sources
  • Baum, C. & Katz, N. (2009) Occupational Therapy Approach to Assessing the Relationship between Cognition and Function. In T. D. Marcotte & I. Grant (Eds.), Neuropsychology of everyday functioning (pp. 62–89). New York: Guilford Press
  • Katz, N. (2005). Cognition and occupation across the life span: Models for intervention in occupational therapy. Bethesda, MD: AOTA Press.
  • Yuen, H.K. (1994). Neurofunctional approach to improve self-care skills in adults with brain damage. Occupational Therapy in Mental Health 12: 31–45.
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