Learning in Post-coma Persons with Profound Multiple Disabilities: Two Case Evaluations

Vegetative state: efforts to curb misdiagnosis

“…Recently, a learning procedure mediated by non-verbal communication was presented as a tool to assess people with profound brain damage and pervasive motor disabilities (Lancioni et al 2007(Lancioni et al , 2008a(Lancioni et al , 2009a. Learning may be defined as a process by which a person acquires knowledge on the relationship between responses and environmental events, suggesting a non-reflective level of phenomenal consciousness (Bosco et al 2009;Schacter 1997;Sun et al 2007).…”

Learning as a possible sign of non-reflective consciousness in persons with a diagnosis of vegetative state and pervasive motor impairment

“…New research is needed to: (a) replicate the use of the learning setups with additional persons having a diagnosis Cogn Process (2009) 10:355-359 357 of vegetative state and pervasive motor disabilities to determine the applicability and limits of such an approach; (b) integrate the learning assessment procedure with new tasks involving different reinforcement conditions or learning paradigms (so as to increase the evidence of learning and strengthen the basis for an inference of minimal consciousness) (Lancioni et al 2008a); and (c) examine possible correlations of the data obtained via learning assessment procedures with other types of data obtained through different behavioral and neurological assessments (Chua et al 2007;Wijnen et al 2007). …”

“…The data for seven of the aforementioned eight participants exposed to the learning setups indicated discrimination of the C from the B phases (Lancioni et al 2007(Lancioni et al , 2008a(Lancioni et al , 2009a, thus suggesting (a) the possibility of changing their diagnostic label from vegetative state to minimally conscious state and (b) the concrete and encouraging perspective of using minimal responses and microswitch technology to help them establish contact with the outside world. Their interaction (basic communication) with the environment could be viewed as: (a) a form of support (enhancement) of their neural plasticity, which is believed to be a fundamental condition to improve learning in situations of severe/extensive brain injury (as already demonstrated in other rehabilitation domains, e.g., Kleim and Jones 2008; Rossini and Dal Forno 2004); (b) a way to improve their situation regarding their immediate impact, overall dignity and social image, and (c) an encouragement for the environment to extend the range of responses to target and the categories of stimuli to contemplate within the daily intervention programs (Lancioni et al 2008b, c;Petry et al 2005;Tsuchiya and Adolphs 2007).…”

“…In light of the above, a method relying on a non-verbally-mediated learning procedure and minimal motor responses has recently been introduced (and experimentally analyzed) as a tool for assessing patients with profound brain injury and pervasive motor disabilities (Lancioni et al 2007(Lancioni et al , 2008a(Lancioni et al , 2009a. Non-verballymediated learning is here viewed as a situation/process whereby a person acquires knowledge of the relationship between objects/events and actions without verbal instructions and without any verbal reporting about it (Graf and Schacter 1985;Schmitter-Edgecombe 2006).…”

“…In the studies by Lancioni et al (2007Lancioni et al ( , 2008aLancioni et al ( , 2009a, learning setups were arranged for eight persons with a diagnosis of vegetative state and pervasive motor impairment. The persons' ages varied between 16 and 68 (M = 47) years.…”