Abstract
This study assessed whether a post-coma woman functioning at the lower end of the minimally conscious state would (a) develop adaptive responding through the use of microswitch technology and contingent stimulation, (b) consolidate and maintain her responding over time, and (c) show evidence of response-consequences awareness (learning and discrimination). The study involved an ABABB1CB1 sequence in which the A represented baseline phases, the B and B1 intervention phases, and the C a control phase with continuous stimulation. Results indicated that the woman developed adaptive responding and consolidated it over the intervention phases of the study. The woman also showed evidence of being aware of response-consequences links. Potential implications and limitations of these findings are discussed.
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References
Barlow DH, Nock M, Hersen M (2009) Single-case experimental designs: strategies for studying behavior change, 3rd edn. Allyn & Bacon, New York
Barreca S, Velikonja D, Brown L, Williams L, Davis L, Sigouin CS (2003) Evaluation of the effectiveness of two clinical training procedures to elicit yes/no responses from patients with a severe acquired brain injury: a randomized single-subject design. Brain Inj 17:1065–1075
Bosco A, Lancioni GE, Olivetti Belardinelli M, Singh NN, O’Reilly MF, Sigafoos J (2009) Learning as a possible sign of non-reflective consciousness in persons with a diagnosis of vegetative state and pervasive motor disabilities. Cogn Process 10:355–359
Bruno MA, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S (2011) From unresponsive wakefulness to minimally conscious PLUS and functional looked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol 258:1373–1384
Canedo A, Grix MC, Nicoletti J (2002) An analysis of assessment instruments for the minimally responsive patient (MRP): clinical observations. Brain Inj 16:453–461
Carter EW, Trainor A, Owens L, Sweden B, Sun Y (2010) Self-determination prospects of youth with high-incidence disabilities: divergent perspectives and related factors. J Emot Behav Disord 18:67–81
Catania AC (2007) Learning, 4th Interim ed. Sloan, New York
Chua KSG, Ng YS, Yap SGM, Bok CW (2007) A brief review of traumatic brain injury rehabilitation. Ann Acad Med Singap 36:31–42
Coleman MR, Pickard JD (2011) Detecting residual cognitive function in disorders of consciousness. Adv Tech Stand Neurosurg 36:3–16
Dimyan MA, Cohen LG (2010) Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke. Neurorehabil Neural Repair 24:125–135
Formisano R, Vinicola V, Penta F, Matteis M, Brunelli S, Weckel JW (2001) Active music therapy in the rehabilitation of severe brain injured patients during coma recovery. Ann Ist Super Sanita 37:627–630
Giacino JT, Kalmar K (2005) Diagnostic and prognostic guidelines for the vegetative and minimally conscious states. Neuropsychol Rehabil 15:166–174
Giacino JT, Trott CT (2004) Rehabilitative management of patients with disorders of consciousness: grand rounds. J Head Trauma Rehabil 19:254–265
Gosseries O, Bruno MA, Chatelle C, Vanhaudenhuyse A, Schnakers C, Soddu A, Laureys S (2011) Disorders of consciousness: what’s in a name? NeuroRehabilitation 28:3–14
Kalmar K, Giacino JT (2005) The JFK coma recovery scale-revised. Neuropsychol Rehabil 15:454–460
Kazdin AE (2001) Behavior modification in applied settings, 6th edn. Wadsworth, New York
Kennedy C (2005) Single case designs for educational research. Allyn & Bacon, New York
Lancioni GE, O’Reilly MF, Singh NN, Buonocunto F, Sacco V, Colonna F, Navarro J, Lanzilotti C, Olivetti Belardinelli M, Bosco A, Megna G, De Tommaso M (2009a) Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state. Dev Neurorehabil 12:411–420
Lancioni GE, O’Reilly MF, Singh NN, Buonocunto F, Sacco V, Colonna F, Navarro J, Oliva D, Megna G, Bosco A (2009b) Technology-based intervention options for post-coma persons with minimally conscious state and pervasive motor disabilities. Dev Neurorehabil 12:24–31
Lancioni GE, Bosco A, Olivetti Belardinelli M, Singh NN, O’Reilly MF, Sigafoos J (2010a) An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state. Res Dev Disabil 31:1121–1134
Lancioni GE, O’Reilly MF, Singh NN, Buonocunto F, Sacco V, Colonna F, Navarro J, Lanzilotti C, Megna G (2010b) Post-coma persons with minimal consciousness and motor disabilities learn to use assistive communication technology to seek environmental stimulation. J Dev Phys Disabil 22:119–129
Lancioni GE, Saponaro F, Singh NN, O’Reilly MF, Sigafoos J, Oliva D (2010c) A microswitch to enable a woman with acquired brain injury and profound multiple disabilities to access environmental stimulation with lip movements. Percept Mot Skills 110:488–492
Lancioni GE, Singh NN, O’Reilly MF, Sigafoos J, Alberti G, Oliva D, Megna G, Iliceto C, Damiani S, Ricci I, Spica A (2011) Post-coma persons with extensive motor disabilities use microswitch technology to access selected stimulation events or operate a radio device. Res Dev Disabil 32:1638–1645
Laureys S, Boly M (2007) What is it like to be vegetative or minimally conscious? Curr Opin Neurol 20:609–613
Magee WL (2005) Music therapy with patients in low awareness states: approaches to assessment and treatment in multidisciplinary care. Neuropsychol Rehabil 15:522–536
Magee WL (2007) Music as a diagnostic tool in low awareness states: considering limbic responses. Brain Inj 21:593–599
Pape TLB, Rosenow J, Lewis G, Ahmed G, Walker M, Guernon A, Roth H, Patil V (2009) Repetitive transcranial magnetic stimulation-associated neurobehavioral gains during coma recovery. Brain Stimul 2:22–35
Schiff ND, Giacino JT, Kalmar K, Victor JD, Baker K, Gerber M, Fritz B, Eisenberg B, O’Connor J, Kobylarz EJ, Farris S, Machado A, McCagg C, Plum F, Fins JJ, Rezai AR (2007) Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature 448(7153):600–603. (Published correction: Nature 452(7183):120)
Siegel S, Castellan NJ (1988) Nonparametric statistics, 2nd edn. McGraw-Hill, New York
Spivey M (2007) The continuity of mind. Oxford University Press, London
Whyte J (2007) Treatments to enhance recovery from the vegetative and minimally conscious states. Am J Phys Med Rehabil 86:86–92
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Lancioni, G.E., Singh, N.N., O’Reilly, M.F. et al. Microswitch technology and contingent stimulation to promote adaptive engagement in persons with minimally conscious state: a case evaluation. Cogn Process 13, 133–137 (2012). https://doi.org/10.1007/s10339-011-0428-6
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DOI: https://doi.org/10.1007/s10339-011-0428-6