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European Journal of Physical and Rehabilitation Medicine 2017 June;53(3):433-40

DOI: 10.23736/S1973-9087.16.04324-0

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Helping people in a minimally conscious state develop responding and stimulation control through a microswitch-aided program

Giulio E., LANCIONI 1 , Nirbhay N. SINGH 2, Mark F., O’REILLY 3, Jeff SIGAFOOS 4, Fiora, D’AMICO 5, 6, Francesca BUONOCUNTO 7, Jorge NAVARRO 7, Crocifissa LANZILOTTI 7, Pietro FIORE 8, Marisa MEGNA 8, Sabino DAMIANI 8, Riccardo MARVULLI 8

1 Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy; 2 Medical College of Georgia, Augusta University, Augusta, GA, USA; 3 Department of Special Education, University of Texas, Austin, TX, USA; 4 School of Education, Victoria University of Wellington, Wellington, New Zealand; 5 Lega F. D’Oro Research Center, Osimo, Ancona, Italy; 6 S. Raffaele Care Center, Alberobello, Bari, Italy; 7 S. Raffaele Rehabilitation Center, Ceglie, Brindisi, Italy; 8 Department of Physical and Rehabilitation Medicine, Polyclinic of Bari, Bari, Italy


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BACKGROUND: Postcoma persons in a minimally conscious state (MCS) and with extensive motor impairment cannot independently access and control environmental stimulation.
AIM: Assessing the effects of a microswitch-aided program aimed at helping MCS persons develop responding and stimulation control and conducting a social validation/evaluation of the program.
DESIGN: A single-subject ABAB design was used for each participant to determine the impact of the program on his or her responding. Staff interviews were used for the social validation/evaluation of the program.
SETTING: Rehabilitation and care facilities that the participants attended.
POPULATION: Eleven MCS persons with extensive motor impairment and lack of speech or any other functional communication.
METHODS: For each participant, baseline (A) phases were alternated with intervention (B) phases during which the program was used. The program relied on microswitches to monitor participants’ specific responses (e.g., prolonged eyelid closures) and on a computer system to enable those responses to control stimulation. In practice, the participants could use a simple response such as prolonged eyelid closure to generate a new stimulation input. Sixty-six staff people took part in the social validation of the program. They were to compare the program to basic and elaborate forms of externally controlled stimulation, scoring each of them on a six-item questionnaire.
RESULTS: All participants showed increased response frequencies (and thus higher levels of independent stimulation input/control) during the B phases of the study. Their frequencies for each intervention phase more than doubled their frequencies for the preceding baseline phase with the difference between the two being clearly significant (P<0.01). Staff involved in the social validation procedure provided significantly higher scoring (P<0.01) for the program on five of the six questionnaire items.
CONCLUSIONS: A microswitch-aided program can be an effective and socially acceptable tool in the work with MCS persons.
CLINICAL REHABILITATION IMPACT: The participants and staff’s data can be taken as an encouragement for the use of a microswitch-aided program within care and rehabilitation settings for MCS persons.


KEY WORDS: Self-help devices - Persistent vegetative state - Program evaluation

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