Assistive technology to help persons in a minimally conscious state develop responding and stimulation control: Performance assessment and social rating

BACKGROUND

Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated.

OBJECTIVE

This study aimed to (a) further assess a technology-aided approach for fostering MCS participants' responding and stimulation control and (b) carry out a social validation check about the approach.

METHODS

Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check.

RESULTS

The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants.

CONCLUSIONS

A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.

Microswitch-aided programs with contingent stimulation versus general stimulation programs for post-coma persons with multiple disabilities

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.

Post-coma persons with extensive multiple disabilities use microswitch technology to access selected stimulus events or operate a radio device

The present two studies extended research evidence on the use of microswitch technology by post-coma persons with multiple disabilities. Specifically, Study I examined whether three adults with a diagnosis of minimally conscious state and multiple disabilities could use microswitches as tools to access brief, selected stimulus events. Study II assessed whether an adult, who had emerged from a minimally conscious state but was affected by multiple disabilities, could manage the use of a radio device via a microswitch-aided program. Results showed that the participants of Study I had a significant increase of microswitch responding during the intervention phases. The participant of Study II learned to change radio stations and seemed to spend different amounts of session time on the different stations available (suggesting preferences among the programs characterizing them). The importance of microswitch technology for assisting post-coma persons with multiple disabilities to positively engage with their environment was discussed.

An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state

This paper presents an overview of the studies directed at helping post-coma persons with minimally conscious state improve their adaptive behavior. Twenty-one studies were identified for the 2000-2010 period (i.e., a period in which an intense debate has occurred about diagnostic, rehabilitative, prognostic, and ethical issues concerning people with severe acquired brain injury). Three of the 21 studies involved transcortical magnetic or deep brain stimulation. Six studies focused on the provision of multisensory stimulation or music therapy. The remaining 12 studies involved the use of response-related (contingent) stimulation and assistive technology. The outcomes of the studies, which were generally reported as positive, were discussed in terms of (a) the size (quantitative relevance) of the changes obtained, (b) the credibility/reliability of the changes, in light of the methodological conditions of the studies, and (c) the level of engagement and interaction involvement of the participants. Relevant issues for future research were also examined.

Persons with Acquired Brain Injury and Multiple Disabilities Access Stimulation Independently through Microswitch-Based Technology

The possibility of enabling two adults with acquired brain injury and profound multiple disabilities to use microswitch-based technology to attain preferred environmental stimuli on their own was assessed. Each of the participants was provided with two microswitches that could be activated by right and left head-turning or head-bending responses. The microswitches were introduced sequentially according to a multiple probe design across microswitches (responses) and allowed access to different sets of auditory or visual stimuli. Eventually, the two microswitches were made available simultaneously. Sessions lasted 5 min. Each participant learned to use the two microswitches successfully and maintained consistent levels of responding when they were simultaneously available. During this phase, both participants showed large within-session variations in their right and left response frequencies, with one of them showing an overall prevalence of the left-side response. The importance of assistive technology within programs for persons with acquired brain injury and multiple disabilities is discussed.

A technology-based programme to help a post-coma man with profound multiple disabilities manage stimulation access and posture improvement

OBJECTIVE

To evaluate a technology-based programme to help a post-coma man with multiple disabilities access stimulation and control head posture (i.e. reduce head forward tilting).

METHOD

The response targeted within the programme was closing the sweater's zipper. This response (which could be repeated since the zipper tended to reopen automatically) was selected, as it led the man to raise his head spontaneously. The programme relied on microswitch sensors to monitor the response and turn on preferred stimuli following response occurrences. The programme was assessed via an ABAB design.

RESULTS

Data showed that the man had significant increases in response frequencies during the intervention phases of the study with multiple occasions of stimulation access and head raising.

CONCLUSION

Technology-assisted programmes may represent a useful strategy for providing post-coma persons with multiple disabilities an active (self-control) role.

Helping a Man With Acquired Brain Injury and Multiple Disabilities Manage Television Use Via Assistive Technology

This single case study was an effort to assess a technology-based program aimed at promoting independent television use by a man with acquired brain injury and multiple disabilities. The technology’s main components were: (a) two microswitches, which allowed the man to request and confirm/trigger with small responses basic television operations (i.e., switching the television on or off and changing channels), and (b) an electronic control unit with an amplified MP3 player, which helped the man with verbal instructions and the execution of the television operations. Results showed that the technology-based program succeeded in enabling the man to manage television use independently. Different amounts of time dedicated to various television programs suggested that the man had different levels of interest for them and could choose among them.

Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state

OBJECTIVE

To evaluate the viability of technology-assisted learning setups for undertaking assessment and providing intervention to persons in vegetative state.

METHOD

Study I investigated whether three persons with a diagnosis of vegetative state could associate eye blinking or hand closure responses with contingent, positive stimulation, thus increasing their frequencies (showing signs of learning). Study II extended the learning process (introducing a new response and new stimuli) for one of the participants of Study I.

RESULTS

Two of the participants of Study I succeeded in increasing their responses, indicating signs of learning. Study II showed that the participant (one of the two succeeding in Study I) acquired a new response to access new stimuli and could alternate this response with the one acquired in Study I.

CONCLUSION

Learning might represent a basic level of knowledge and consciousness. Detecting signs of learning might help modify a previous diagnosis of vegetative state and support intervention/rehabilitation efforts.

Microswitch- and VOCA-assisted programs for two post-coma persons with minimally conscious state and pervasive motor disabilities

Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with minimally conscious state and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music intervals, and (b) a voice output communication aid (VOCA) with two channels, activated via different hand-closure movements, which allowed the man to call his mother and a research assistant who provided stimulation events. Study II assessed a program that included (a) a pressure microswitch, activated via head movements, which allowed a man direct access to video-clips and music, and (b) a VOCA device, activated via prolonged eyelid closure, which allowed the man to call the caregiver (i.e., a research assistant) who provided attention and sung to him. Each of the two participants had significant increases in both microswitch- and VOCA-related responses during the intervention phases of the studies. Moreover, purposeful choice seemed to occur between the two VOCA responses in Study I. Implications of the findings for improving the situation of post-coma persons with minimally conscious state and pervasive motor disabilities are discussed.

A technology-assisted learning setup as assessment supplement for three persons with a diagnosis of post-coma vegetative state and pervasive motor impairment

Post-coma persons in an apparent condition of vegetative state and pervasive motor impairment pose serious problems in terms of assessment and intervention options. A technology-based learning assessment procedure might serve for them as a diagnostic supplement with possible implications for rehabilitation intervention. The learning assessment procedure adopted in this study relied on hand-closure and eye-blinking responses and on microswitch technology to detect such responses and to present stimuli. Three participants were involved in the study. The technology consisted of a touch/pressure sensor fixed on the hand or an optic sensor mounted on an eyeglasses' frame, which were combined with a control system linked to stimulus sources. The study adopted an ABABCB sequence, in which A represented baseline periods, B intervention periods with stimuli contingent on the responses, and C a control condition with stimuli presented non-contingently. Data showed that the level of responding during the B phases was significantly higher than the levels observed during the A phases as well as the C phase for two of the three participants (i.e., indicating clear signs of learning by them). Learning might be deemed to represent basic levels of knowledge/consciousness. Thus, detecting signs of learning might help one revise a previous diagnosis of vegetative state with wide implications for rehabilitation perspectives.

A learning setup for a post-coma adolescent with profound multiple disabilities involving small forehead movements and new microswitch technology

PURPOSE

A learning setup was arranged for an adolescent with profound multiple disabilities and a diagnosis of vegetative state. Signs of learning by the adolescent would underline an improvement in his immediate situation with potential implications for his general prospect, and could help revise his diagnosis.

METHOD

The response adopted in the learning setup was forehead skin movement. The microswitch technology used for detecting such a response consisted of (a) an optic sensor (i.e., barcode reader), (b) a small tag with horizontal bars attached to the participant's forehead, and (c) an electronic control system that activated stimuli in relation to the participant's forehead responses. The study followed an ABABACAB sequence, in which A represented baseline periods, B intervention periods with stimuli contingent on the response, and C a control condition with stimuli presented non-contingently.

RESULTS

Data showed that the level of responding during the B phases was significantly higher than the levels observed during the A phases as well as the C phase, indicating clear signs of learning.

CONCLUSIONS

Intervention strategies based on a learning format and suitable technology might be useful to improve the situation and prospect of persons with profound multiple disabilities and a diagnosis of vegetative state.

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

BACKGROUND

Intervention strategies, based on learning principles and assistive technology, were assessed with four post-coma persons with minimally conscious state and pervasive motor disabilities.

METHOD

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.

RESULTS

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.

CONCLUSION

Intervention strategies based on learning principles and technology may be largely helpful for persons with minimally conscious state and pervasive motor disabilities.