Treating Special Populations
MARK S. SCHWARTZ
Little is known about the clinical utility of biofeedback and related procedures for people with developmental disabilities, although the work of Calamari, Geist, and Shahbazian (1987) points out the potential of surface electromyographic (EMG) biofeedback. The research to date (Lindsay, Baty, Michie, & Richardson, 1989) has mainly focused on a special relaxation approach developed by Shilling and Poppen (1983), termed behavioral relaxation training (BRT). This approach is illustrated in the following case. (Note that, as in other chapters, italics on first use of a term indicate that the term is included in the chapter's glossary.)
Michultka, Poppen, and Blanchard (1988) applied BRT to treat the migraine and frequent tension-type headache symptoms of a 29-year-old male patient with severe functional retardation. At age 7, he was diagnosed with autism, which was attributed to anoxia at birth. Administration of the Stanford–Binet Intelligence Scale at age 26 revealed an IQ below 30. He used one- and two-word phrases and echolalia to express himself and was inconsistent in responding to requests. However, he revealed some gross and fine motor skills, and he could complete some basic self-care skills. He was also able to verbalize headache presence by stating, "I have a headache."
BRT consisted of modeling, prompting, feedback, and positive reinforcement for sequentially shaping and reducing tension in 10 muscle groupings. The therapist began by demonstrating how to relax the hands, applying the BRT procedures as appropriate, and continuing with the next posture (attempts to have the client demonstrate both tension and relaxation proved to be too difficult). Relaxed postures were required to be maintained for increasingly longer intervals in order for verbal reinforcement to be delivered (beginning with 5 seconds and continuing to 60 seconds). A relaxed posture was considered to be acquired when it could be maintained for two 60-second intervals. A small amount of iced tea was used to reinforce compliance, in addition to the verbal reinforcement. Nineteen sessions were used in all (10 for acquisition training, 9 for proficiency training).
The Behavioral Relaxation Scale (BRS) was administered during the final 10 minutes of each session in order to assess relaxation progress. With the BRS, the client was shown to