Technology-aided programs for post-coma patients emerged from or in a minimally conscious state

Abstract

Post-coma persons in a minimally conscious state (MCS) or emerged/emerging from such state (E-MCS), who are affected by extensive motor impairment and lack of speech, may develop an active role and interact with their environment with the help of technology-aided intervention programs. Although a number of studies have been conducted in this area during the last few years, new evidence about the efficacy of those programs is warranted. These three studies were an effort in that direction. Study I assessed a technology-aided program to enable six MCS participants to access preferred environmental stimulation independently. Studies II and III assessed technology-aided programs to enable six E-MCS participants to make choices. In Study II, three of those participants were led to choose among leisure and social stimuli, and caregiver interventions automatically presented to them. In Study III, the remaining three participants were led to choose (a) among general stimulus/intervention options (e.g., songs, video-recordings of family members, and caregiver interventions); and then (b) among variants of those options. The results of all three studies were largely positive with substantial increases of independent stimulation access for the participants of Study I and independent choice behavior for the participants of Studies II and III. The results were analyzed in relation to previous data and in terms of their implications for daily contexts working with MCS and E-MCS persons affected by multiple disabilities.

A Behavioral Approach to Treatment and Assessment of People with Disorders of Consciousness: The Response-contingent Stimulation Strategy

“…A fifth difference concerns the goal of the stimulation process. In the responsecontingent stimulation strategy, the stimulation events are used not simply as means to foster arousal and brain activation (as it typically occurs in the other strategies), but also as a way to motivate/reinforce specific behavioral responses of the patient (i.e., the responses that are followed by those events) with the view of increasing and strengthening the patient's performance of those responses [15,50,53,58,59].…”

“…In essence, the brief stimulation periods are delivered immediately after the emission of those specific responses. The responses targeted for stimulation delivery are typically selected based on the fact that (a) they are already present in the patients' repertoire but have a low frequency of occurrence (so such frequency could be increased by a successful stimulation process; see below), and (b) they can be recorded in a reliable manner [51][52][53][54][55].…”

“…Learning such a link enables them to acquire a level of self-determination, an active role within their own context, and thus ensure that they can be in charge of their stimulation input rather than being simple recipients of externally determined stimulation deliveries [15,55,58,65]. The acquisition of such an active role and the underlying learning process may be viewed as highly valuable phenomena/experiences with relevant therapeutic implications for the advancement of the patients' recovery process [15,50,51,53,55,[66][67][68]. The application of this strategy in the treatment of MCS patients has been reported in 14 studies including a total of 64 patients [50][51][52][53][54]64,[69][70][71][72][73][74][75][76].…”

“…The acquisition of such an active role and the underlying learning process may be viewed as highly valuable phenomena/experiences with relevant therapeutic implications for the advancement of the patients' recovery process [15,50,51,53,55,[66][67][68]. The application of this strategy in the treatment of MCS patients has been reported in 14 studies including a total of 64 patients [50][51][52][53][54]64,[69][70][71][72][73][74][75][76]. Some of those studies are summarized below as a way to clarify how the strategy is set up and how it can work with the patients.…”

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

“…Moreover, the AT based interventions should be developed keeping in mind both human and financial resources available in daily contexts [14]. Accordingly, future perspective in this research area should deal with the following topics: (a) enlarging the number of participants involved, (b) the AT-based options rigorously customer-tailored to the users, (c) conducting new social validation assessment with new groups of experts involved, and (d) providing preference checks phases for participants who emerged or are emerging from minimally conscious states [15].…”