Gordon Muir Giles is a professor at Samuel Merritt University in Oakland California

California

California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...

 and a Fellow of the American Occupational Therapy

Occupational therapy

Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...

 Association. He is best known for his work in rehabilitation following traumatic brain injury

Traumatic brain injury

Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...

 (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 behavior disorder (sometimes referred to as relational therapy).

Education and early career

Giles received his undergraduate degree from the University of Warwick

University of Warwick

The University of Warwick is a public research university located in Coventry, United Kingdom...

, UK and his PhD from the California School of Professional Psychology

California School of Professional Psychology

The California School of Professional Psychology , was founded by the California Psychological Association in 1969. It is part of Alliant International University.The school has trained approximately half of the licensed psychologists in California...

, USA. He was trained in rehabilitation of persons with TBI in the early 1980s at the Kemsley Unit of St Andrew's Hospital

St Andrew's Hospital

St Andrew's Hospital in Northampton, England is a psychiatric hospital run by a non-profit-making, charitable trust. It is by far the largest mental health facility in UK, providing national specialist services for adolescents, men, women and older people with mental illness, learning disability,...

, UK. The Kemsley unit was the first program to use applied behavioral analysis principles to rehabilitation of persons with behavior disorder after TBI, and his publications from this period are straightforward applications of behavioral methods to TBI. Noteworthy however is the first application of errorless learning

Errorless learning

Errorless learning is a procedure introduced by Herbert Terrace which allows discrimination learning to occur with few or even with no responses to the negative stimulus . A negative stimulus is a stimulus associated with undesirable consequences...

 principles to this population (though the term errorless learning was not used).

Neurofunctional approach

A full description of the Neurofunctional approach was published in 1993. Although highly influenced by applied behavioral 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). A randomized controlled trial (RCT) reported by Vanderploeg and co-workers, 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. In the professional language of occupational therapists the Neurofunctional Approach is described as a frame of reference, and an occupation based approach.

Applied behavior analysis

More recently, Gordon Muir Giles has been reporting on interventions for persons with acquired neurological impairments and behavior disorder. Beginning in the 1980s applied behavior analysis principles were introduced for use with persons with TBI. By the late 1990s however it was recognized that up to a third of persons with TBI and behavior disorder were unable to make use of standard behavioral interventions. Non-aversive approaches to behavior disorder after TBI are consistent with concepts in psychiatric rehabilitation and positive behavioral supports in work with persons with mental retardation but were developed independently from them. The interventions stress a philosophy of normalization, respect, non-confrontation, positive engagement, support, and functional and behavioral skill development. The approach is based on the observation that much of the behavioral 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 behavior. Evidence is currently limited to small-scale proof of concept designs and the approaches have not been subjected to randomized controlled investigations.

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.