Technology-based intervention options for post-coma persons with minimally conscious state and pervasive motor disabilities.

University of Bari, Bari, Italy.
Developmental neurorehabilitation 07/2009; 12(1):24-31. DOI: 10.1080/17518420902776995
Source: PubMed

ABSTRACT Intervention strategies, based on learning principles and assistive technology, were assessed with four post-coma persons with minimally conscious state and pervasive motor disabilities.
The first study taught a man to access environmental stimulation through a response-microswitch combination and another man to access environmental stimulation and request social contact through responses combined with a microswitch or a Voice Output Communication Aid (VOCA). The second study taught a man to access two forms of environmental stimulation via two response-microswitch combinations and another man to request two forms of contact via two response-VOCA combinations.
Data showed that all participants had significant increases in response levels (independent of whether the responses were combined with microswitch or VOCA devices) during the intervention phases of the studies.
Intervention strategies based on learning principles and technology may be largely helpful for persons with minimally conscious state and pervasive motor disabilities.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: Assessing the impact of microswitch-aided programs with contingent stimulation on response engagement (Study I) and post-session alertness (Study II) of post-coma participants with multiple disabilities. Method: Study I included three participants whose scores on the Coma Recovery Scale-Revised (CRS-R) were 11 or 13. Study II included three participants whose CRS-R scores were 19, 13, and 14. In both studies, the participants received sessions with contingent stimulation (i.e., sessions in which activation of a microswitch with an eyelid or hand response produced 15 s of preferred stimulation) and sessions with general, non-contingent stimulation (i.e., stimulation lasted throughout the sessions). Results: Study I showed an increase in response engagement/frequencies only during the contingent stimulation sessions. Study II showed that the participants' level of vigilance after those sessions was higher than after non-contingent stimulation sessions. Conclusion: Microswitch-aided programs with contingent stimulation would be more beneficial than programs with general/non-contingent stimulation.
    Developmental neurorehabilitation 07/2013; DOI:10.3109/17518423.2013.793751
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Post-coma persons with multiple disabilities may represent a challenge to rehabilitation centers, due to their clinical conditions. Moreover, they can failed to engage adaptive responses aimed at the self-management of environmental stimuli. OBJECTIVES: To assess the impact and social rating of a new assistive technology set-up for promoting constructive engagement by two post-coma boys emerged from a minimal conscious state. METHOD: During baseline sessions, the participants were provided with a mouse to manage the computer system. During intervention phases, a new technology was implemented, allowing both participants to manage environmental stimuli with a microswitch instead of the mouse. Furthermore, a social validation assessment was carried out, involving students as raters. RESULTS: Data showed an increasing of constructive engagement by both participants during intervention phases. Sixty psychology students (social raters) favoured the new technology on a six items questionnaire (i.e. enjoyment, suitability, rehabilitation, independence, daily context and support). CONCLUSIONS: The new technology was suitable, affordable, effective and socially preferable.
    Neurorehabilitation 07/2014; 35(2). DOI:10.3233/NRE-141112 · 1.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Post-coma persons in a minimally conscious state and with extensive motor impairment or emerging/emerged from such a state, but affected by lack of speech and motor impairment, tend to be passive and isolated. A way to help them develop functional responding to control environmental events and communication involves the use of intervention programs relying on assistive technology. This paper provides an overview of technology-based intervention programs for enabling the participants to (a) access brief periods of stimulation through one or two microswitches, (b) pursue stimulation and social contact through the combination of a microswitch and a sensor connected to a speech generating device (SGD) or through two SGD-related sensors, (c) control stimulation options through computer or radio systems and a microswitch, (d) communicate through modified messaging or telephone systems operated via microswitch, and (e) control combinations of leisure and communication options through computer systems operated via microswitch. Twenty-six studies, involving a total of 52 participants, were included in this paper. The intervention programs were carried out using single-subject methodology, and their outcomes were generally considered positive from the standpoint of the participants and their context. Practical implications of the programs are discussed.
    Frontiers in Human Neuroscience 02/2014; 8:48. DOI:10.3389/fnhum.2014.00048 · 2.90 Impact Factor
    This article is viewable in ResearchGate's enriched format