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Stasolla F, Caffò AO, Bottiroli S, Ciarmoli D. An assistive technology program for enabling five adolescents emerging from a minimally conscious state to engage in communication, occupation, and leisure opportunities. Dev Neurorehabil 2022; 25:193-204. [PMID: 34895026 DOI: 10.1080/17518423.2021.2011457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Post-coma patients emerging from a minimally conscious state may have extensive motor disabilities and pose serious challenges to medical centers and home settings. OBJECTIVES To promote academic performance and communication skills of post-coma individuals with traumatic brain injuries emerging from a minimally conscious state through an Assistive Technology setup. To evaluate its effects on the participants' positive participation. To generalize the learning process. To assess the intervention's clinical and social validity. METHOD Study I included five adolescents exposed to an Assistive Technology setup enabling them with targeted adaptive behaviors. Study II involved fifty external raters in a social validation assessment. RESULTS Data evidenced an improved performance of all the participants during the intervention, assessed through a concurrent multiple baseline design across participants. Social raters favorably scored the use of the technology. CONCLUSION An Assistive Technology setup may be helpful to enhance the performance and positive participation of adolescents with traumatic brain injuries emerging from a minimally conscious state.
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Affiliation(s)
| | - Alessandro O Caffò
- Department of Educational Sciences, Psychology, Communication, University "Aldo Moro", Bari, Italy
| | - Sara Bottiroli
- "Giustino Fortunato" University of Benevento, Benevento, Italy.,IRCCS Mondino Foundation, Pavia, Italy
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Brunner M, Hemsley B, Togher L, Palmer S. Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI). Brain Inj 2017; 31:1028-1043. [DOI: 10.1080/02699052.2017.1292429] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melissa Brunner
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Bronwyn Hemsley
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia
| | - Stuart Palmer
- Faculty of Science, Engineering & Built Environment, Deakin University, Geelong, Australia
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, D'Amico F, Buonocunto F, Navarro J, Lanzilotti C, Fiore P, Megna M, Damiani S. Assistive technology to help persons in a minimally conscious state develop responding and stimulation control: Performance assessment and social rating. NeuroRehabilitation 2016; 37:393-403. [PMID: 26518532 DOI: 10.3233/nre-151269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated. OBJECTIVE This study aimed to (a) further assess a technology-aided approach for fostering MCS participants' responding and stimulation control and (b) carry out a social validation check about the approach. METHODS Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check. RESULTS The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants. CONCLUSIONS A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.
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Affiliation(s)
| | - Nirbhay N Singh
- Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | | | | | | | | | - Jorge Navarro
- S. Raffaele Rehabilitation Center, Ceglie Messapica, Italy
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Chen M, Hyppa-Martin JK, Reichle JE, Symons FJ. Comparing Single Case Design Overlap-Based Effect Size Metrics From Studies Examining Speech Generating Device Interventions. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 121:169-93. [PMID: 27119210 PMCID: PMC5313391 DOI: 10.1352/1944-7558-121.3.169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Meaningfully synthesizing single case experimental data from intervention studies comprised of individuals with low incidence conditions and generating effect size estimates remains challenging. Seven effect size metrics were compared for single case design (SCD) data focused on teaching speech generating device use to individuals with intellectual and developmental disabilities (IDD) with moderate to profound levels of impairment. The effect size metrics included percent of data points exceeding the median (PEM), percent of nonoverlapping data (PND), improvement rate difference (IRD), percent of all nonoverlapping data (PAND), Phi, nonoverlap of all pairs (NAP), and Tau(novlap). Results showed that among the seven effect size metrics, PAND, Phi, IRD, and PND were more effective in quantifying intervention effects for the data sample (N = 285 phase or condition contrasts). Results are discussed with respect to issues concerning extracting and calculating effect sizes, visual analysis, and SCD intervention research in IDD.
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Affiliation(s)
- Mo Chen
- Mo Chen, University of Minnesota, Minneapolis, MN
| | - Jolene K Hyppa-Martin
- Jolene K. Hyppa-Martin, University of Minnesota, Minneapolis, MN and University of Minnesota Duluth, Duluth, MN
| | - Joe E Reichle
- Joe E. Reichle, University of Minnesota, Minneapolis, MN; and
| | - Frank J Symons
- Frank J. Symons, University of Minnesota, Minneapolis, MN
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Lancioni GE, Singh NN, O'Reilly MF, Green VA, Buonocunto F, Sacco V, Navarro J, Lanzilotti C, Olivetti Belardinelli M. Microswitch-aided programs with contingent stimulation versus general stimulation programs for post-coma persons with multiple disabilities. Dev Neurorehabil 2014; 17:251-8. [PMID: 23869535 DOI: 10.3109/17518423.2013.793751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Assessing the impact of microswitch-aided programs with contingent stimulation on response engagement (Study I) and post-session alertness (Study II) of post-coma participants with multiple disabilities. METHOD Study I included three participants whose scores on the Coma Recovery Scale-Revised (CRS-R) were 11 or 13. Study II included three participants whose CRS-R scores were 19, 13, and 14. In both studies, the participants received sessions with contingent stimulation (i.e., sessions in which activation of a microswitch with an eyelid or hand response produced 15 s of preferred stimulation) and sessions with general, non-contingent stimulation (i.e., stimulation lasted throughout the sessions). RESULTS Study I showed an increase in response engagement/frequencies only during the contingent stimulation sessions. Study II showed that the participants' level of vigilance after those sessions was higher than after non-contingent stimulation sessions. CONCLUSION Microswitch-aided programs with contingent stimulation would be more beneficial than programs with general/non-contingent stimulation.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari , Bari , Italy
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Lancioni GE, Bellini D, Oliva D, Singh NN, O'Reilly MF, Green VA, Furniss F. New camera-based microswitch technology to monitor small head and mouth responses of children with multiple disabilities. Dev Neurorehabil 2014; 17:193-9. [PMID: 23323933 DOI: 10.3109/17518423.2012.758186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Assessing a new camera-based microswitch technology, which did not require the use of color marks on the participants' face. METHOD Two children with extensive multiple disabilities participated. The responses selected for them consisted of small, lateral head movements and mouth closing or opening. The intervention was carried out according to a multiple probe design across responses. The technology involved a computer with a CPU using a 2-GHz clock, a USB video camera with a 16-mm lens, a USB cable connecting the camera and the computer, and a special software program written in ISO C++ language. RESULTS The new technology was satisfactorily used with both children. Large increases in their responding were observed during the intervention periods (i.e. when the responses were followed by preferred stimulation). CONCLUSION The new technology may be an important resource for persons with multiple disabilities and minimal motor behavior.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari , Italy
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Lancioni GE, Bosco A, Olivetti Belardinelli M, Singh NN, O'Reilly MF, Sigafoos J, Oliva D. Technology-based intervention programs to promote stimulation control and communication in post-coma persons with different levels of disability. Front Hum Neurosci 2014; 8:48. [PMID: 24574992 PMCID: PMC3920651 DOI: 10.3389/fnhum.2014.00048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/21/2014] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari Bari, Italy
| | - Andrea Bosco
- Department of Educational Science, Psychology, Communication, University of Bari Bari, Italy
| | | | - Nirbhay N Singh
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University Augusta, GA, USA
| | - Mark F O'Reilly
- Department of Special Education, University of Texas at Austin Austin, TX, USA
| | - Jeff Sigafoos
- Department of Educational Psychology, Victoria University of Wellington Wellington, New Zealand
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Assistive Technology for People with Severe/Profound Intellectual and Multiple Disabilities. AUTISM AND CHILD PSYCHOPATHOLOGY SERIES 2014. [DOI: 10.1007/978-1-4899-8029-8_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Objectives: To summarise available evidence for responsiveness of six key assessments used with patients with disorders of consciousness: Coma Recovery Scale – Revised (CRS-R), Disorders Of Consciousness Scale (DOCS), Sensory Modality Assessment and Rehabilitation Technique (SMART), Sensory Stimulation Assessment Measure (SSAM), Wessex Head Injury Matrix (WHIM), and the Western Neuro Sensory Stimulation Profile (WNSSP).Method: A literature search of five electronic databases was conducted using a systematic search strategy. Relevant literature was evaluated and pertinent information extracted.Results: Database searches using key terms initially yielded 132 articles. Following review for inclusion identified 24 articles. No studies were specifically designed to investigate responsiveness of any of the measures and therefore responsiveness data were either based on statistical significance of change post-treatment or descriptive analysis of change scores. The majority of studies identified used the CRS-R (n= 11), WHIM (n= 5) and WNSSP (n= 6) and have established responsiveness to change. There is some preliminary evidence for the responsiveness of the other measures, based on very few available studies: DOCS (n= 2), SMART (n= 1) or SSAM (n= 1).Conclusion: Future studies should seek to include responsiveness analysis, particularly in relation to the DOCS, SMART and SSAM.
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Lancioni GE, O'Reilly MF, Singh NN, Sigafoos J, Green VA, Oliva D, Alberti G, Carrella L. Two women with multiple disabilities communicate with distant partners via a special text messaging system. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:397-403. [PMID: 23009946 DOI: 10.1016/j.ridd.2012.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 08/30/2012] [Indexed: 06/01/2023]
Abstract
This study extended the research on a special text messaging system, which allows persons with multiple disabilities to (a) write and send messages to distant partners and (b) have messages from those partners read out to them. The study involved two women with multiple disabilities (including blindness or minimal residual vision). The system comprised a net-book computer, a mobile communication modem, and an input microswitch, and relied on special keyboards (not used before) to allow the women to write their messages. One of the keyboards included (a) two rows of 10 and 11 keys, respectively, reporting the 21 basic letters of the Italian alphabet arranged in alphabetical order and marked with Braille labels and (b) a space bar and an enlarged back/erase key. The other keyboard had Braille cues on the initial, central, and final keys of the letter rows. Moreover, most function keys were covered (cut out from the usable space). Both women learned to use the messaging system with the special keyboards successfully (i.e., to write their messages, to send them out, and to listen to incoming messages). These findings are analyzed in relation to preliminary data with the system and the need to adapt the writing technology to the participants' characteristics.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy.
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Lancioni GE, Bellini D, Oliva D, Singh NN, O'Reilly MF, Sigafoos J, Lang R. Two persons with multiple disabilities use camera-based microswitch technology to control stimulation with small mouth and eyelid responses. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2012; 37:337-342. [PMID: 23025528 DOI: 10.3109/13668250.2012.726351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND A camera-based microswitch technology was recently developed to monitor small facial responses of persons with multiple disabilities and allow those responses to control environmental stimulation. This study assessed such a technology with 2 new participants using slight variations of previous responses. METHOD The technology involved a computer with a CPU using a 2GHz clock, a USB video camera with 16-mm lens, and special software. Small colour spots were used under the lower lip of one participant and on the eyelid of the other participant to aid the camera and computer to detect their mouth and eyelid responses. The study involved an ABAB design and included a 3-week post-intervention check. RESULTS The participants' mouth and eyelid responses increased during the intervention (B) phases and post-intervention check (i.e., when the technology allowed them to control stimulation). CONCLUSIONS Camera-based microswitch technology can help persons with multiple disabilities control stimulation with small responses.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy.
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Belardinelli MO, Buonocunto F, Sacco V, Navarro J, Lanzilotti C, De Tommaso M, Megna M, Badagliacca F. Promoting adaptive behavior in persons with acquired brain injury, extensive motor and communication disabilities, and consciousness disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1964-1974. [PMID: 22738766 DOI: 10.1016/j.ridd.2012.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 05/29/2012] [Indexed: 06/01/2023]
Abstract
These two studies extended the evidence on the use of technology-based intervention packages to promote adaptive behavior in persons with acquired brain injury and multiple disabilities. Study I involved five participants in a minimally conscious state who were provided with intervention packages based on specific arrangements of optic, tilt, or pressure microswitches (linked to preferred environmental stimuli) and eyelid, toe and finger responses. Study II involved three participants who were emerging from a minimally conscious state and were provided with intervention packages based on computer presentations of stimulus options (i.e., preferred stimuli, functional caregiver's procedures, and non-preferred stimuli) and pressure microswitches to choose among them. Intervention data of Study I showed that the participants acquired relatively high levels of microswitch responding (thus engaging widely with preferred environmental stimuli) and kept that responding consistent except for one case. Intervention data of Study II showed that the participants were active in choosing among preferred stimuli and positive caregivers' procedures, but generally abstained from non-preferred stimuli. The results were discussed in terms of the successful use of fairly new/infrequent microswitch-response arrangements (Study I) and the profitable inclusion of functional caregiver's procedures among the options available to choice (Study II).
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Italy.
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Ricci I, Buonocunto F, Sacco V. Access to environmental stimulation via eyelid responses for persons with acquired brain injury and multiple disabilities: a new microswitch arrangement. Percept Mot Skills 2012; 114:353-62. [PMID: 22755440 DOI: 10.2466/15.27.pms.114.2.353-362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assessed a new microswitch arrangement for eyelid responses using an optic sensor placed above the cheekbone and a small sticker on the person's eyelid. This new arrangement, which was designed to avoid interference of the microswitch with the person's visual functioning, was tested on three adults with acquired brain injury and multiple (consciousness, communication, and motor) disabilities. The study was carried out according to a non-concurrent multiple baseline design across participants. Data showed the new microswitch arrangement was suitable for all three participants, who increased their responding during the intervention phase of the study when their responses allowed them to access preferred stimulation. Practical implications of the findings are discussed.
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Lancioni GE, O'Reilly MF, Singh NN, Green VA, Oliva D, Buonocunto F, Colonna F, Navarro J. Special text messaging communication systems for persons with multiple disabilities. Dev Neurorehabil 2012; 15:31-8. [PMID: 22256832 DOI: 10.3109/17518423.2011.631594] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To expand recently-developed text messaging systems with new technology-based solutions so as to allow persons with multiple disabilities to write messages. METHOD Two case studies were conducted. In Study I, the new technology-based solution involved vocal scanning of the alphabet letters to allow letter selection/writing and was assessed with a woman with blindness and extensive motor disability. In Study II, the new technology-based solution involved a touch-screen superimposed on letter symbols arranged alphabetically and was assessed with a man with acquired brain injury, motor disability and lack of speech. Each study involved an ABAB design. RESULTS Participants learned to write their messages, to send them out and to listen to incoming messages during intervention sessions of nearly 30 and 20 minutes, respectively. CONCLUSION Text messaging systems can be developed that allow participants with multiple disabilities to write messages.
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Affiliation(s)
- Giulio E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, Bari, Italy.
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Lancioni GE, Bellini D, Oliva D, Singh NN, O'reilly MF, Lang R, Didden R, Bosco A. Persons with multiple disabilities select environmental stimuli through a smile response monitored via camera-based technology. Dev Neurorehabil 2012; 14:267-73. [PMID: 21810016 DOI: 10.3109/17518423.2011.584605] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess whether two persons with multiple disabilities could use smile expressions and new camera-based microswitch technology to select environmental stimuli. METHOD Within each session, a computer system provided samples/reminders of preferred and non-preferred stimuli. The camera-based microswitch determined whether the participants had smile expressions in relation to those samples. If they did, stimuli matching the specific samples to which they responded were presented for 20 seconds. RESULTS The smile expression could be profitably used by the participants who managed to select means of ∼70% or 75% of the preferred stimulus opportunities made available by the environment while avoiding almost all the non-preferred stimulus opportunities. CONCLUSION Smile expressions (a) might be an effective and rapid means for selecting preferred stimulation and (b) might develop into cognitively more elaborate forms of responding through the learning experience (i.e. their consistent association with positive/reinforcing consequences).
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Amenduni MT, Navarro J, Buonocunto F, Scarabino T, Belardinelli MO. Microswitch technology and contingent stimulation to promote adaptive engagement in persons with minimally conscious state: a case evaluation. Cogn Process 2011; 13:133-7. [PMID: 22131129 DOI: 10.1007/s10339-011-0428-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 11/15/2011] [Indexed: 11/28/2022]
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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Affiliation(s)
- Giulio E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, 70100, Bari, Italy.
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Alberti G, Oliva D, Megna G, Iliceto C, Damiani S, Ricci I, Spica A. Post-coma persons with extensive multiple disabilities use microswitch technology to access selected stimulus events or operate a radio device. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1638-1645. [PMID: 21398091 DOI: 10.1016/j.ridd.2011.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/12/2011] [Indexed: 05/30/2023]
Abstract
The present two studies extended research evidence on the use of microswitch technology by post-coma persons with multiple disabilities. Specifically, Study I examined whether three adults with a diagnosis of minimally conscious state and multiple disabilities could use microswitches as tools to access brief, selected stimulus events. Study II assessed whether an adult, who had emerged from a minimally conscious state but was affected by multiple disabilities, could manage the use of a radio device via a microswitch-aided program. Results showed that the participants of Study I had a significant increase of microswitch responding during the intervention phases. The participant of Study II learned to change radio stations and seemed to spend different amounts of session time on the different stations available (suggesting preferences among the programs characterizing them). The importance of microswitch technology for assisting post-coma persons with multiple disabilities to positively engage with their environment was discussed.
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Affiliation(s)
- Giulio E Lancioni
- Department of Psychology, University of Bari, and Bari University Hospital, Via Quintino Sella 268, 70100 Bari, Italy.
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Lancioni G, Singh N, O'Reilly M, Signorino M, Alberti G, Scigliuzzo F, Oliva D. Adapting a computer-assisted program to help a post-coma man with extensive multiple disabilities choose stimulus events. Dev Neurorehabil 2011; 13:433-9. [PMID: 21034287 DOI: 10.3109/17518423.2010.519761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To adapt an existing computer-assisted program to help a post-coma man with extensive multiple disabilities choose between stimulus events. METHOD An adapted version of the program assessed in this study presented the man with 7-second samples of preferred and non-preferred stimuli, without questions, and allowed him to choose any of them through a vocalization response. The man's use of this response to choose a stimulus sample led the computer to present the matching stimulus for 20 seconds. The same response used immediately after the end of the 20-second stimulus presentation led to the repetition of that presentation. RESULTS The adapted program version was effective in promoting high levels of choice among preferred stimuli and virtually no responding in relation to non-preferred stimuli. Indices of happiness were frequent during the program sessions. CONCLUSIONS Computer-assisted programs for stimulus choice might be successfully adapted to post-coma persons with extensive disabilities.
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Affiliation(s)
- Giulio Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, Bari, Italy.
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Lancioni GE, Bellini D, Oliva D, Singh NN, O'Reilly MF, Sigafoos J. Camera-based microswitch technology for eyelid and mouth responses of persons with profound multiple disabilities: two case studies. RESEARCH IN DEVELOPMENTAL DISABILITIES 2010; 31:1509-1514. [PMID: 20598501 DOI: 10.1016/j.ridd.2010.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 06/07/2010] [Indexed: 05/29/2023]
Abstract
These two studies assessed camera-based microswitch technology for eyelid and mouth responses of two persons with profound multiple disabilities and minimal motor behavior. This technology, in contrast with the traditional optic microswitches used for those responses, did not require support frames on the participants' face but only small color marks. The person involved in Study I had previously used optic sensors fixed on an eyeglasses' frame for detecting his eyelid- and mouth-opening responses. However, a deterioration of his head posture was making the correct location/use of this frame progressively more difficult. The person involved in Study II had previously been selected for a program relying on eyelid-closure responses and an optic sensor. Such a program however appeared difficult to implement given his sideward lying position and dystonic head movements. The new technology could be satisfactorily applied with both participants using mouth and eyelid opening with the first participant and eyelid closures with the second participant. Both participants had large increases in responding during the intervention periods (i.e., when their responses were followed by preferred stimulation). The findings are discussed in relation to the role of the new technology in helping persons with multiple disabilities and minimal motor behavior.
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Affiliation(s)
- Giulio E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy.
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Lancioni GE, Bosco A, Belardinelli MO, Singh NN, O'Reilly MF, Sigafoos J. An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state. RESEARCH IN DEVELOPMENTAL DISABILITIES 2010; 31:1121-1134. [PMID: 20663643 DOI: 10.1016/j.ridd.2010.06.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 06/22/2010] [Indexed: 05/29/2023]
Abstract
This paper presents an overview of the studies directed at helping post-coma persons with minimally conscious state improve their adaptive behavior. Twenty-one studies were identified for the 2000-2010 period (i.e., a period in which an intense debate has occurred about diagnostic, rehabilitative, prognostic, and ethical issues concerning people with severe acquired brain injury). Three of the 21 studies involved transcortical magnetic or deep brain stimulation. Six studies focused on the provision of multisensory stimulation or music therapy. The remaining 12 studies involved the use of response-related (contingent) stimulation and assistive technology. The outcomes of the studies, which were generally reported as positive, were discussed in terms of (a) the size (quantitative relevance) of the changes obtained, (b) the credibility/reliability of the changes, in light of the methodological conditions of the studies, and (c) the level of engagement and interaction involvement of the participants. Relevant issues for future research were also examined.
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Lancioni GE, O'Reilly MF, Singh NN, Sigafoos J, Buonocunto F, Sacco V, Navarro J, Addante LM, D'Agostino I. Persons with Acquired Brain Injury and Multiple Disabilities Access Stimulation Independently through Microswitch-Based Technology. Percept Mot Skills 2010; 111:485-95. [DOI: 10.2466/15.17.23.pms.111.5.485-495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The possibility of enabling two adults with acquired brain injury and profound multiple disabilities to use microswitch-based technology to attain preferred environmental stimuli on their own was assessed. Each of the participants was provided with two microswitches that could be activated by right and left head-turning or head-bending responses. The microswitches were introduced sequentially according to a multiple probe design across microswitches (responses) and allowed access to different sets of auditory or visual stimuli. Eventually, the two microswitches were made available simultaneously. Sessions lasted 5 min. Each participant learned to use the two microswitches successfully and maintained consistent levels of responding when they were simultaneously available. During this phase, both participants showed large within-session variations in their right and left response frequencies, with one of them showing an overall prevalence of the left-side response. The importance of assistive technology within programs for persons with acquired brain injury and multiple disabilities is discussed.
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Affiliation(s)
| | - Mark F. O'Reilly
- Meadows Center for Preventing Educational Risk, University of Texas at Austin
| | | | | | - Francesca Buonocunto
- S. Raffaele Rehabilitation and Care Centers, Ceglie Messapica and Modugno, Italy
| | - Valentina Sacco
- S. Raffaele Rehabilitation and Care Centers, Ceglie Messapica and Modugno, Italy
| | - Jorge Navarro
- S. Raffaele Rehabilitation and Care Centers, Ceglie Messapica and Modugno, Italy
| | - Luigi M. Addante
- S. Raffaele Rehabilitation and Care Centers, Ceglie Messapica and Modugno, Italy
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Lancioni GE, Singh NN, O’Reilly MF, Sigafoos J, Signorino M, Oliva D, Alberti G, Carrella L, de Tommaso M. A special messaging technology for two persons with acquired brain injury and multiple disabilities. Brain Inj 2010; 24:1236-43. [DOI: 10.3109/02699052.2010.506857] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lancioni G, O'Reilly M, Singh N, Oliva D, D'Amico F, Megna G, Buonocunto F, Sacco V. A technology-based programme to help a post-coma man with profound multiple disabilities manage stimulation access and posture improvement. Dev Neurorehabil 2010; 13:212-6. [PMID: 20450471 DOI: 10.3109/17518421003652858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate a technology-based programme to help a post-coma man with multiple disabilities access stimulation and control head posture (i.e. reduce head forward tilting). METHOD The response targeted within the programme was closing the sweater's zipper. This response (which could be repeated since the zipper tended to reopen automatically) was selected, as it led the man to raise his head spontaneously. The programme relied on microswitch sensors to monitor the response and turn on preferred stimuli following response occurrences. The programme was assessed via an ABAB design. RESULTS Data showed that the man had significant increases in response frequencies during the intervention phases of the study with multiple occasions of stimulation access and head raising. CONCLUSION Technology-assisted programmes may represent a useful strategy for providing post-coma persons with multiple disabilities an active (self-control) role.
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Helping a Man With Acquired Brain Injury and Multiple Disabilities Manage Television Use Via Assistive Technology. Clin Case Stud 2010. [DOI: 10.1177/1534650110378036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This single case study was an effort to assess a technology-based program aimed at promoting independent television use by a man with acquired brain injury and multiple disabilities. The technology’s main components were: (a) two microswitches, which allowed the man to request and confirm/trigger with small responses basic television operations (i.e., switching the television on or off and changing channels), and (b) an electronic control unit with an amplified MP3 player, which helped the man with verbal instructions and the execution of the television operations. Results showed that the technology-based program succeeded in enabling the man to manage television use independently. Different amounts of time dedicated to various television programs suggested that the man had different levels of interest for them and could choose among them.
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Lancioni G, O'Reilly M, Singh N, Buonocunto F, Sacco V, Colonna F, Navarro J, Lanzilotti C, Belardinelli MO, Bosco A, Megna G, de Tommaso M. Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state. Dev Neurorehabil 2010; 12:411-20. [PMID: 20205550 DOI: 10.3109/17518420903200581] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the viability of technology-assisted learning setups for undertaking assessment and providing intervention to persons in vegetative state. METHOD Study I investigated whether three persons with a diagnosis of vegetative state could associate eye blinking or hand closure responses with contingent, positive stimulation, thus increasing their frequencies (showing signs of learning). Study II extended the learning process (introducing a new response and new stimuli) for one of the participants of Study I. RESULTS Two of the participants of Study I succeeded in increasing their responses, indicating signs of learning. Study II showed that the participant (one of the two succeeding in Study I) acquired a new response to access new stimuli and could alternate this response with the one acquired in Study I. CONCLUSION Learning might represent a basic level of knowledge and consciousness. Detecting signs of learning might help modify a previous diagnosis of vegetative state and support intervention/rehabilitation efforts.
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Vegetative state: efforts to curb misdiagnosis. Cogn Process 2009; 11:87-90. [PMID: 20043186 DOI: 10.1007/s10339-009-0355-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Buonocunto F, Sacco V, Colonna F, Navarro J, Oliva D, Signorino M, Megna G. Microswitch- and VOCA-assisted programs for two post-coma persons with minimally conscious state and pervasive motor disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2009; 30:1459-1467. [PMID: 19660902 DOI: 10.1016/j.ridd.2009.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 07/09/2009] [Indexed: 05/28/2023]
Abstract
Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with minimally conscious state and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music intervals, and (b) a voice output communication aid (VOCA) with two channels, activated via different hand-closure movements, which allowed the man to call his mother and a research assistant who provided stimulation events. Study II assessed a program that included (a) a pressure microswitch, activated via head movements, which allowed a man direct access to video-clips and music, and (b) a VOCA device, activated via prolonged eyelid closure, which allowed the man to call the caregiver (i.e., a research assistant) who provided attention and sung to him. Each of the two participants had significant increases in both microswitch- and VOCA-related responses during the intervention phases of the studies. Moreover, purposeful choice seemed to occur between the two VOCA responses in Study I. Implications of the findings for improving the situation of post-coma persons with minimally conscious state and pervasive motor disabilities are discussed.
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Affiliation(s)
- Giulio E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy.
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