Technology-based intervention programs to promote stimulation control and communication in post-coma persons with different levels of disability

Abstract

Post-coma persons in a minimally conscious state and with extensive motor impairment or emerging/emerged from such a state, but affected by lack of speech and motor impairment, tend to be passive and isolated. A way to help them develop functional responding to control environmental events and communication involves the use of intervention programs relying on assistive technology. This paper provides an overview of technology-based intervention programs for enabling the participants to (a) access brief periods of stimulation through one or two microswitches, (b) pursue stimulation and social contact through the combination of a microswitch and a sensor connected to a speech generating device (SGD) or through two SGD-related sensors, (c) control stimulation options through computer or radio systems and a microswitch, (d) communicate through modified messaging or telephone systems operated via microswitch, and (e) control combinations of leisure and communication options through computer systems operated via microswitch. Twenty-six studies, involving a total of 52 participants, were included in this paper. The intervention programs were carried out using single-subject methodology, and their outcomes were generally considered positive from the standpoint of the participants and their context. Practical implications of the programs are discussed.

Sensory stimulation for patients with disorders of consciousness: from stimulation to rehabilitation

“…This would involve structured and meaningful stimuli that would be delivered to multiple sensory channels in an integrated and simultaneous way. It would address both input and output cognitive processing and involve dynamic and naturalistic actions that would avoid meaningless repetitive and frequent stimulations (Lancioni et al, 2014 ). This would, therefore, include stimulations with proper intensity which would be occasionally interspersed with intense stimuli.…”

“…This context predisposes to select simple and repetitive stimuli, often without emotional salience and autobiographical content, and aimed to stimulate only the input processing. We believe that naturalistic, dynamic actions in an appropriate context aimed at selecting specific behavioral scripts (e.g., having breakfast with the family) could represent a better choice for a renewed SS (Lancioni et al, 2014 ). Naturalistic tasks in real or virtual situations involve complex stimuli, call both for input and output processing, and are ideal backgrounds for introducing emotional and autobiographical stimuli.…”

Assessment and Intervention with Patients with Severe Disorders of Consciousness

“…In its more elaborate forms, this approach involves specific daily sessions with the presentation of intensive multisensory stimulation, a physically and verbally guided manipulation of relevant daily objects or exposure to emotional and autobiographical stories (e.g., Di Stefano et al 2012;Pape et al 2015). The most basic forms of stimulation are considered unlikely to have a significant impact on the patients' levels of attention and direct involvement with the context or their long-term recovery prospects (Abbate et al 2014;Lancioni et al 2014b;Lombardi et al 2002). The intensive/elaborate and emotionally charged forms of stimulation are considered more likely to have positive effects on the patients' behavior and recovery process (Di Stefano et al 2012;Lotze et al 2011;Pape et al 2015).…”

“…Regarding intervention, multiple procedures (e.g., environmental and brain stimulation) have been advocated to improve the condition of patients with disorders of consciousness (Di Stefano et al 2012;Georgiopoulos et al 2010;Lancioni et al 2014b;Lotze et al 2011;Pape et al 2015). Those procedures indicate diverse types of emphasis and theoretical backgrounds, which have clear implications (a) for the role of the assessment (for deciding whether the functioning level of the patient should be determined prior to the intervention) and (b) for the role of the patient within the intervention program set up for him or her (Hauger et al 2015(Hauger et al , 2017Lancioni et al 2014a).…”

Assistive Technology-based Programs for Promoting Independence of Post-coma Children

“…Whenever the adaptive responding varying according to the aforementioned experimental phases, one may argue on participant favorable diagnosis of minimally conscious state [7]. For individuals in a minimally conscious state, one may adopt vocal output communication aid (VOCA) issues, aimed at requesting social contact with one or more caregivers [8].…”