Promoting adaptive behavior in persons with acquired brain injury, extensive motor and communication disabilities, and consciousness disorders

These two studies extended the evidence on the use of technology-based intervention packages to promote adaptive behavior in persons with acquired brain injury and multiple disabilities. Study I involved five participants in a minimally conscious state who were provided with intervention packages based on specific arrangements of optic, tilt, or pressure microswitches (linked to preferred environmental stimuli) and eyelid, toe and finger responses. Study II involved three participants who were emerging from a minimally conscious state and were provided with intervention packages based on computer presentations of stimulus options (i.e., preferred stimuli, functional caregiver's procedures, and non-preferred stimuli) and pressure microswitches to choose among them. Intervention data of Study I showed that the participants acquired relatively high levels of microswitch responding (thus engaging widely with preferred environmental stimuli) and kept that responding consistent except for one case. Intervention data of Study II showed that the participants were active in choosing among preferred stimuli and positive caregivers' procedures, but generally abstained from non-preferred stimuli. The results were discussed in terms of the successful use of fairly new/infrequent microswitch-response arrangements (Study I) and the profitable inclusion of functional caregiver's procedures among the options available to choice (Study II).

Persons with mild or moderate Alzheimer's disease learn to use urine alarms and prompts to avoid large urinary accidents

This study assessed whether three patients with Alzheimer's disease could learn to use urine alarms and caregivers' prompts to eliminate large urinary accidents. As soon as the patient began to release urine, the alarm system presented auditory and vibratory signals. In relation to those signals, the caregiver would prompt/encourage the patient to stop urinating and accompany him or her to the toilet to void. After urination, the caregiver provided the patient positive social attention. The results of the intervention showed that the use of the alarm system and caregivers' prompts was effective in helping the three patients reduce their large urinary accidents to zero or near zero levels. Self-initiated toileting, which was minimal during baseline, accounted for nearly 35%, 50% and 75% of the patients' toileting occasions during the intervention. Fifty-two caregivers, who participated in a social validation assessment of toileting approaches relying on alarm systems or timed toileting, seemed to find the former preferable for the patients, for the context, as well as for themselves. The implications of the findings for daily programs of patients with Alzheimer's disease and other dementias are discussed.