Uso de la técnica de economía de fichas para incrementar conductas de tratamiento en adultos mayores con sarcopenia / Use of a token economy to increase target behaviors in older people with sarcopenia

La sarcopenia está caracterizada por la baja masa y fuerza muscular en los adultos mayores. La implementación de técnicas de modificación de la conducta como la técnica de economía de fichas (TEF) puede fungir como estrategia para mejorar la adherencia al tratamiento. El objetivo fue evaluar el efecto de la TEF sobre las conductas de tratamiento: realizar la rutina de ejercicio de resistencia, consumir el suplemento de proteína y consumir el suplemento de vitamina D. Se realizó un estudio de caso de múltiples sujetos en ocho adultos mayores con sarcopenia. El estudio estuvo conformado por tres fases: pre-intervención, intervención conductual y post-intervención conductual. Se evaluó la frecuencia de las conductas de tratamiento en las tres fases, además de los cambios en masa y fuerza muscular. El análisis de los datos se realizó por medio de estadística descriptiva. Los resultados mostraron que la frecuencia de las conductas de tratamiento aumentó en el 100% de los participantes en la etapa de intervención conductual al comparar con la fase pre-intervención, valores que no regresaron a cero en la fase post-intervención conductual. El 83.3 % de los participantes dejaron de tener el diagnóstico de sarcopenia con base en los cambios de masa y fuerza muscular.

Sarcopenia is characterized by low muscle mass and strength in older adults. It is caused by decreased physical activity and quality of dietary intake. Therefore, the implementation of behavior modification techniques such as the token economy technique can serve as a strategy to improve treatment. The aim of the current study was to evaluate the effect of the token economy technique on treatment behaviors. A multiple case studies with an ABC-type design was conducted in eight older adults with sarcopenia. The intervention consisted of modification of treatment-related behaviors; in addition, changes in muscle mass and strength were assessed. The results showed that the frequency of target behaviors increased in 100% of the participants in the intervention stage compared to baseline. The frequency of the target behaviors did not return to the obtained baseline compared to the maintenance stage. 83.3% of the participants changed their sarcopenia diagnosis.

Modification of Severe Violent and Aggressive Behavior among Psychiatric Inpatients through the Use of a Short-Term Token Economy

PURPOSE: Meager research has been carried out to determine the effectiveness of the token economy among patients behaving violently in mental hospitals. The purpose of this study was to examine the effectiveness of the Short-Term Token Economy (STTE) on violent behavior among chronic psychiatric in-patients. METHODS: A nonequivalent control group design method was utilized. Participants in an experimental group (n=22) and control group (n=22) took part in this study from January to April, 2008. Observation on aggressive behavior among male in-patients in one hospital as a baseline was made during the week before the behavior modification program and measurement of aggressive behavior was done using the Overt Aggression Scale (OAS), which includes verbal attacks, property damage and physical attacks. RESULTS: The aggressive behavior scores of the experimental group decreased, those of the control group, scores showed an increase after the eight-week behavior modification program utilizing STTE. CONCLUSION: The results of the study indicate that STTE is effective in reducing the incidence of aggressive behavior among male in-patients in psychiatric hospitals. The outcome of this study should be helpful in reducing the use of coercive measures or psychoactive medication in controlling the violent behavior among in-patients in hospitals.

Programa de economía de fichas en el hogar / A home-based token economy program

Se aplica un programa de economía de fichas para modificar algunos comportamientos disruptivos de un niño. Se pretende decrementar el contestar de manera inadecuada, así como hacer pataletas y propiciar la ocurrencia del seguimiento de instrucciones relacionadas con conductas como arreglar la cama, recoger y organizar los juguetes, recoger y organizar la ropa, hacer sus deberes escolares. Se hace una profunda revisión de la aplicación del programa de Economía de Fichas en diversos campos y problemas de conducta. Siguiendo un diseño ABA, los resultados confirman el cambio de comportamiento y logran un mejor ajuste de la conducta del niño en la escuela y el ambiente familiar. Se hace un análisis desde algunos principios de la economía conductual.

It applies a token economy program to modify some disruptive behaviors of a child. It is intended to decrease the answer in an inappropriate manner and make tantrums and encourage the occurrence of follow-up instructions for behaviors such as to fix the bed, collecting and organizing toys, collect and organize your clothes, do their homework. It is a thorough review of the implementation of the token economy in various fields and behavioral problems. Following an ABA design, the results confirm the behavior change made a better adjustment of the child's behavior at school and home environment. An analysis is made from some of the principles of behavioral economics.

Efectos de un programa combinado de técnicas de modificación conductual para la disminución de la conducta disruptiva y el aumento de la conducta prosocial en escolares chilenos / Effects of a combined program of behavior modification techniques for decreasing disruptive behavior and increasing prosocial behavior in Chilean school children / Efeitos de um programa combinado de técnicas de modificação de comportamento para reduzir o comportamento perturbador e aumentar o comportamento prosocial em escolares chilenos

El objetivo de la presente investigación fue evaluar la eficacia de un programa de intervención conductual en la disminución de la frecuencia de conductas disruptivas y en el aumento de la frecuencia de conductas prosociales en el contexto escolar. Con este objetivo se entrenó a una profesora en el empleo de una serie de técnicas de modificación conductual (instrucciones, alabanza verbal y economía de fichas) para que ella las aplicara a un curso de primer año de enseñanza secundaria que presentaba serios desajustes conductuales. Se utilizó un diseño de reversión ABAB con seguimiento para evaluar el desempeño de la profesora en las técnicas de modificación conductual enseñadas y su efecto en el grupo-curso. Los resultados indican que la profesora logró aplicar de manera apropiada las técnicas de modificación conductual produciendo los cambios deseados en el comportamiento de los alumnos del curso.

The objective of this research was to evaluate the effectiveness of a behavioral intervention program on the reduction of disruptive behavior, and the increase of prosocial behavior in a classroom context. In order to do so, the class teacher received training in the use of a series of behavior modification techniques (namely instructions, verbal praise and token economy). After training the teacher, she implemented the procedures in a first year class of secondary school that presented severe behavioral problems. A reversal design ABAB was used in order to evaluate the performance of the teacher in the implementation of the behavioral modification techniques taught and to evaluate the effect of these techniques on the group. Results indicated that the teacher was able to implement appropriately all the behavior modification techniques. The implemented procedures were in turn able to generate the desired changes in student behavior during class time.

Esta pesquisa avaliou a eficácia de um programa de intervenção comportamental para reduzir a freqüência de comportamentos perturbadores e aumentar os comportamentos prosociais no contexto escolar. Portanto, uma professora treinada no uso de uma série de técnicas de modificação do comportamento (instruções, louvor verbal e economia de fichas) as aplicou em um curso do primeiro ano do ensino secundário que tinha sérios desajustes comportamentais. Foi utilizado um desenho de reversão ABAB com seguimento para avaliar o desempenho da professora nas técnicas ensinadas de modificação comportamental e seu efeito no grupo-curso. Os resultados revelam a professora aplicou apropriadamente as técnicas de modificação comportamental produzindo os resultados esperados no comportamento dos alunos do curso.

A Study on Health Education Program Development of Respiratory Communicable Disease Prevention for Preschool Children and the Measurement of It's Effects / 아동간호학회지

PURPOSE: The purpose of this study were to develop a respiratory communicable disease prevention program for preschoolers and measure it's effects. METHOD: The respiratory communicable disease prevention program for preschoolers consisted of texts, cartoons, photographs, discussions, demonstrations, puzzle games, die games, compensation/reinforcement, and token economy which were directed under the systematic design of instruction by Dick & Carey. This study was a quasi experimental study under the nonequivalent control group with pretest-posttest design. The subjects of this study were 45 preschool children who are attending 3 different district nursery schools and they were matched by the age, pretest knowledge, and pretest behavior. The instrument used in this study was criterion referenced test items that were developed by a researcher for evaluating the subject's knowledge, attitude, and behavior about respiratory communicable disease prevention. A pretest was administered a week before treatment. Experimental group I was administered by the treatment of respiratory communicable disease prevention program. Experimental group II was administered by above program with token economy program. The posttest was conducted on the eighth day. The third test for behavior was completed 15th day. To determine the effect of the program, the data were analyzed by the SAS 6.12 program with Kruskal Wallis test, ANCOVA, ANOVA, Duncan's test and paired t-test. RESULT: 1) There was a significant difference in knowledge between the experimental groups and control group(F=5.89, P=0.0197). 2) There was a significant difference in attitude between the experimental groups and control group(F=3.29, P=0.0469). 3) There was a non-significant difference in behavior between the experimental groups and control group(F=0.00, P=0.9512). 4) In the experimental group II, there was highly significant increase in behavior after token economy(t=4.5252, P=0.0005). CONCLUSION: It was found that the respiratory communicable disease prevention program for preschool children was effective in changing the preschoolers' knowledge and attitude on the respiratory communicable disease prevention, but not enough for changing the preschoolers' behavior. Token economy was improved as an effective and strong method for inducing desirable changes of preschoolers' behavior.

The Effectiveness of Token economy on Oral Medication for Discharged Children / 아동간호학회지

Oral medication is the most frequent treatment measure for follow up treatment, which is leading by childrens' parents for them. In medication for preoperational children, they tend to concentrate the result rather than the motivation or cause. So, they frequently refuse medication which has bitter taste. So this study was attempted to develop token economy program which promote children's medication and help their parents, and to evaluate its' effect to construct the experimental ground. This study was a quasi experimental study under the nonequivalent control group posttest only design. The subjects of this study were 36 children who were aged 3-6 years and admitted pediatric ward because of their respiratory disease. Token economy program was consisted of cartoon record paper with stickers which expresses the better medication is taken the more germs die, and gift was given for back up reinforcer. To evaluate this program, time for oral medication was measured to both experimental group and control group. To determine the effect of the program, the data were analyzed by the SAS 6.12 program with t-test. The results of this study were as follows: 1. Between experimental group and control group, there was no significant difference (t=-1.2411, P=0.2374). Therefore, the hypothesis of this study was rejected. In conclusion, the token economy program for follow up care didn't change the children's behavior of oral medication. But it was found that the cartoon on recording paper gave a pleasure to participated children. Parents who were in experimental group expressed their appreciation for token economy program. So it can be said that the token economy program for follow up care was effective in inducing the children's pleasure and parents' satisfaction even though it wasn't successful in experiment. If the measuring tools for token economy program was made with well planned design and high reliability, it can be improved the effectiveness of that To develope the theoretical bases of nursing care, the well planned programs and measuring tools for them should be developed.

A Study of the Effectiveness of Token Economy on Children's Behaviors for Oral Medication / 아동간호학회지

Oral medication is one of the most frequent treatment in clinical care, and frequently refused by children. Children's refusal spends unuseful time and require nurses' patience. So this study was attempted to develop token economy program which promote children's medication, and to evaluate its' effect to construct the experimental ground. This study was a quasi experimental study under the nonequivalent control group non-synchronized design. The subjects of this study were 48 children who were aged 3-12 years and admitted pediatric ward because of their respiratory disease. Token economy program was consisted of cartoon record paper with stickers which expresses the better medication is taken the more germs die, and gift was given for back up reinforcer. To evaluate this program, time spent for oral medication was measured six time to both experimental group and control group, and measured the perceived effectiveness of this program by nurses. To determine the effect of the program, the data were analyzed by the SAS 6.12 program with t-test and mean, standard deviation. The results of this study were as follows: 1. In experimental group, time spent for oral medication was significantly shorter than in control group(t=5.24, p=0.0001). Therefore, the hypothesis of this study was strongly accepted. 2. Nurses perceived this program as an effective one(mean=3.125 ~ 3.792). The effectiveness occurred before, during and after medication as well as in parental responses, especially in using verbal dissatisfaction after medication. In conclusion, it was found that the token economy program for admitted children was effective in inducing the children's behavior of oral medication. There was no effectiveness in very highly anxious children. Whereas, it is recommended that this program should not be used for such children until they settle down. If the token economy program was made in various situation with creative thinking, it will be very useful nursing measurement, especially in caring for children. To improve the quality of nursing care, the various programs, which can give joyfulness to stressed patients should be developed.

Efforts and Therapeutic Factors of Short-term Token Economy for Negative Symptoms of Schizophrenic In-patients / 신경정신의학

OBJECTIVE: The negative symptoms of schizophrenia usually are not responsive to drug therapy to persist and make schizophrenics more difficult in their rehabilitation. The authors investigated the therapeutic effect of token economy(TET) for negative symptoms of schizophrenic patients, and attempted to develop a TET program f3r psychiatric wards in general hospital. METHODS: Negative subscale of PANSS was rated for 35 schizophrenics with negative symptoms as their main problems before and after short-term TET(less than 3 months). Therapeutic factors were identified by comparing patient and program variables between the achieved and the non-achieved group of each level of target behaviors. RESULTS: 1) Subtotal of negative subscale of PANSS was decreased from 31.57+/-4.32 at baseline to 20.66+/-4.63 artier treatment. With TET, symptoms of difficulty in abstract thinking' and 'stereotypic thinking' were less responsive than the other 5 items of the scale Also the dose of antipsychotics prescribed was reduced to 291.21+/-287.74mg/day from 487.58+/-372.79mg/day. 2) The achievement rate of level I (self-help) was 75%, level II (ward-activity) 78%, and level III (social activity/occupation) 68%, resulting in average 74% for all target behaviors. 3) On level II, dose of antipsychotics was lower, and on level III, number of admission was lower and female sex was more frequent in achieving patient group than nonachieving group. The rate of achievement was higher in case of special flood, reception, and outing with family applied as a reinforcer on level I, and reception on level II . CONCLUSION: These results showed that TET was effective for schizophrenic patients with negative symptoms in psychiatric ward. Further investigations to refine the individual program of TET will be needed far enhancement of it s therapeutic efficacy and smart application of it.