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

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.

[1]  F. Manes,et al.  Assessing level of consciousness and cognitive changes from vegetative state to full recovery , 2005, Neuropsychological rehabilitation.

[2]  M. Freeman,et al.  Assistive technologies and other support for people with brain impairment , 2013 .

[3]  M. Schorl,et al.  Integration of intensive care treatment and neurorehabilitation in patients with disorders of consciousness: a program description and case report. , 2013, Archives of physical medicine and rehabilitation.

[4]  Nirbhay N. Singh,et al.  Microswitch-aided programs with contingent stimulation versus general stimulation programs for post-coma persons with multiple disabilities , 2014, Developmental neurorehabilitation.

[5]  Francisco Javier Díaz Pernas,et al.  A Kinect-based system for cognitive rehabilitation exercises monitoring , 2014, Comput. Methods Programs Biomed..

[6]  D. Man,et al.  Quality of Life of Individuals with Acquired Brain Injuries , 2010 .

[7]  A. Liberati,et al.  Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review , 2002, Clinical rehabilitation.

[8]  G. King,et al.  “This is my way”: reimagining disability, in/dependence and interconnectedness of persons and assistive technologies , 2012, Disability and rehabilitation.

[9]  R. Piperno,et al.  Increased behavioural responsiveness with complex stimulation in VS and MCS: Preliminary results , 2012, Brain injury.

[10]  Technology-aided programs to enable persons with multiple disabilities to choose among environmental stimuli using a smile or a tongue response. , 2013, Research in developmental disabilities.

[11]  B. D. Jong "Complete Motor Locked-In" and Consequences for the Concept of Minimally Conscious State , 2013 .

[12]  USING HISTORY TO STRENGTHEN A RESEARCH METHODS COURSE , 2010 .

[13]  J. Giacino Sensory stimulation: theoretical perspectives and the evidence for effectiveness. , 1996, NeuroRehabilitation.

[14]  F. Etcharry-Bouyx,et al.  Post-acute assessment programme for patients with traumatic brain injury: Measuring the gap between patients’ expectations on entering and end of programme recommendations , 2013, Brain injury.

[15]  Marta Olivetti Belardinelli,et al.  Microswitch technology and contingent stimulation to promote adaptive engagement in persons with minimally conscious state: a case evaluation , 2011, Cognitive Processing.

[16]  Nirbhay N. Singh,et al.  Technology-assisted programmes to promote leisure engagement in persons with acquired brain injury and profound multiple disabilities: two case studies , 2011, Disability and rehabilitation. Assistive technology.

[17]  Carolina Colomer,et al.  Behavioral recovery in disorders of consciousness: a prospective study with the Spanish version of the Coma Recovery Scale-Revised. , 2012, Archives of physical medicine and rehabilitation.

[18]  N. Birbaumer,et al.  A long-term intensive behavioral treatment study in patients with persistent vegetative state or minimally conscious state. , 2011, Journal of rehabilitation medicine.

[19]  Nirbhay N. Singh,et al.  Technology-aided leisure and communication opportunities for two post-coma persons emerged from a minimally conscious state and affected by multiple disabilities. , 2013, Research in developmental disabilities.

[20]  Z. Kefalopoulou,et al.  Vegetative State and Minimally Conscious State: A Review of the Therapeutic Interventions , 2010, Stereotactic and Functional Neurosurgery.

[21]  Justin B. Rowe,et al.  Design and preliminary evaluation of the FINGER rehabilitation robot: controlling challenge and quantifying finger individuation during musical computer game play , 2014, Journal of NeuroEngineering and Rehabilitation.

[22]  Helena Lindstedt,et al.  Cognitive assistive technology and professional support in everyday life for adults with ADHD , 2013, Disability and rehabilitation. Assistive technology.

[23]  A O Posatskiy,et al.  Design and evaluation of a novel microphone-based mechanomyography sensor with cylindrical and conical acoustic chambers. , 2012, Medical engineering & physics.

[24]  Diana Velikonja,et al.  Evaluation of the effectiveness of two clinical training procedures to elicit yes/no responses from patients with a severe acquired brain injury: a randomized single-subject design , 2003, Brain injury.

[25]  Nirbhay N. Singh,et al.  A Social Validation Assessment of Microswitch-Based Programs for Persons with Multiple Disabilities Employing Teacher Trainees and Parents as Raters , 2006 .

[26]  Ying Mao,et al.  Cortical activity after emotional visual stimulation in minimally conscious state patients. , 2009, Journal of neurotrauma.

[27]  W. Magee,et al.  Music therapy with patients in low awareness states: Approaches to assessment and treatment in multidisciplinary care , 2005, Neuropsychological rehabilitation.

[28]  R. Henson,et al.  Social Validation of Evidence-Based Practices in Autism by Parents, Teachers, and Administrators , 2008, Journal of autism and developmental disorders.

[29]  Alan Foley,et al.  Technology for people, not disabilities: ensuring access and inclusion , 2012 .

[30]  R. Seel,et al.  Specialized early treatment for persons with disorders of consciousness: program components and outcomes. , 2013, Archives of physical medicine and rehabilitation.

[31]  Nirbhay N. Singh,et al.  Access to Environmental Stimulation via Eyelid Responses for Persons with Acquired Brain Injury and Multiple Disabilities: A New Microswitch Arrangement , 2012, Perceptual and motor skills.

[32]  W. Mann,et al.  Cost, Utilization, and Policy of Provision of Assistive Technology Devices to Veterans Poststroke by Medicare and VA , 2010, Medical care.

[33]  Alan E. Kazdin,et al.  Behavior modification in applied settings, 6th ed. , 1989 .

[34]  Jeff Sigafoos,et al.  Assistive Technology: Interventions for Individuals with Severe/Profound and Multiple Disabilities , 2012 .

[35]  Nirbhay N. Singh,et al.  Persons with multiple disabilities use forehead and smile responses to access or choose among technology-aided stimulation events. , 2013, Research in developmental disabilities.

[36]  Nirbhay N. Singh,et al.  Assessing learning as a possible sign of consciousness in post-coma persons with minimal responsiveness , 2014, Front. Hum. Neurosci..

[37]  W. W. Daniel Applied Nonparametric Statistics , 1979 .

[38]  A. Mazzucchi,et al.  Sensory stimulation for patients with disorders of consciousness: from stimulation to rehabilitation , 2014, Front. Hum. Neurosci..

[39]  P. Enderby,et al.  Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: a systematic review and qualitative synthesis. , 2012, International journal of language & communication disorders.

[40]  A. E. Kazlxn,et al.  Behavior Modification in Applied Settings , 1975 .

[41]  A. Mihailidis,et al.  Cognitive Assistive Technology , 2006 .

[42]  T. Chau,et al.  A Review of EEG-Based Brain-Computer Interfaces as Access Pathways for Individuals with Severe Disabilities , 2013, Assistive technology : the official journal of RESNA.

[43]  Marta Olivetti Belardinelli,et al.  An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state. , 2010, Research in developmental disabilities.

[44]  Janice Light,et al.  The iPad and Mobile Technology Revolution: Benefits and Challenges for Individuals who require Augmentative and Alternative Communication , 2013, Augmentative and alternative communication.

[45]  Nirbhay N. Singh,et al.  Technology-aided recreation and communication opportunities for post-coma persons affected by lack of speech and extensive motor impairment. , 2013, Research in developmental disabilities.

[46]  Carl D. Cheney,et al.  Behavior Analysis and Learning , 1998 .

[47]  John Whyte,et al.  Treatments to enhance recovery from the vegetative and minimally conscious states: ethical issues surrounding efficacy studies. , 2007, American journal of physical medicine & rehabilitation.

[48]  J. Giacino,et al.  The JFK coma recovery scale—revised , 2005, Neuropsychological rehabilitation.

[49]  G. Wall,et al.  Evaluation of neuropsychological rehabilitation following severe traumatic brain injury: A case report , 2013, Neurocase.

[50]  R. Tate,et al.  Sequence of recovery during the course of emergence from the minimally conscious state. , 2007, Archives of physical medicine and rehabilitation.

[51]  V. Munde,et al.  Alertness in individuals with profound intellectual and multiple disabilities: a literature review. , 2009, Research in developmental disabilities.

[52]  Nirbhay N. Singh,et al.  Enabling Persons with Acquired Brain Injury and Multiple Disabilities to Choose among Environmental Stimuli and Request their Repetition via a Technology-assisted Program , 2011 .

[53]  D. Frankoff,et al.  Augmentative and Alternative Communication in Daily Clinical Practice: Strategies and Tools for Management of Severe Communication Disorders , 2011, Topics in stroke rehabilitation.

[54]  Åsa Gardelli,et al.  ‘I know, I can, I will try’: youths and adults with intellectual disabilities in Sweden using information and communication technology in their everyday life , 2013 .

[55]  É. Dutil,et al.  Clinical efficacy of stimulation programs aimed at reversing coma or vegetative state (VS) following traumatic brain injury. , 2002, Acta neurochirurgica. Supplement.

[56]  E. Kendall,et al.  Missing discourses: concepts of joy and happiness in disability , 2009 .

[57]  M. Sherer,et al.  Emergence from minimally conscious state , 2009, Neurology.

[58]  Marcia J. Scherer Assistive technologies and other supports for people with brain impairment , 2011 .

[59]  S. McNamee,et al.  Treatment of Disorders of Consciousness in the Veterans Health Administration Polytrauma Centers , 2012, The Journal of head trauma rehabilitation.

[60]  Gernot R. Müller-Putz,et al.  A Single-Switch BCI Based on Passive and imagined movements: toward Restoring Communication in Minimally Conscious patients , 2013, Int. J. Neural Syst..

[61]  D. Barlow,et al.  Single Case Experimental Designs: Strategies for Studying Behavior Change , 1976 .

[62]  N. Schiff,et al.  Central Thalamic Deep Brain Stimulation to Promote Recovery from Chronic Posttraumatic Minimally Conscious State: Challenges and Opportunities , 2012, Neuromodulation : journal of the International Neuromodulation Society.

[63]  R. Goebel,et al.  Brain–computer interfaces for communication with nonresponsive patients , 2012, Annals of neurology.

[64]  James A Lenker,et al.  Consumer perspectives on assistive technology outcomes , 2013, Disability and rehabilitation. Assistive technology.

[65]  L. Borell,et al.  Computer-based assistive technology and changes in daily living after stroke , 2012, Disability and rehabilitation. Assistive technology.

[66]  A. Fingelkurts,et al.  Emerging from an unresponsive wakefulness syndrome: Brain plasticity has to cross a threshold level , 2013, Neuroscience & Biobehavioral Reviews.

[67]  J. Whyte,et al.  Disorders of consciousness: outcomes, comorbidities, and care needs. , 2013, Archives of physical medicine and rehabilitation.

[68]  Peter Secretan Learning , 1965, Mental Health.

[69]  Jacquie Ripat,et al.  The intersection of culture, disability and assistive technology , 2011, Disability and rehabilitation. Assistive technology.

[70]  Alexis Roche,et al.  Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1-4 year follow-up. , 2009, Progress in brain research.

[71]  Patricia Baldwin,et al.  The Importance of Self-Determination to Perceived Quality of Life for Youth and Young Adults With Chronic Conditions and Disabilities , 2010 .

[72]  Steven Laureys,et al.  From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness , 2011, Journal of Neurology.

[73]  J. Berry,et al.  Predictors of health-related quality-of-life following traumatic brain injury , 2013, Brain injury.

[74]  W. Magee Music as a diagnostic tool in low awareness states: Considering limbic responses , 2007, Brain injury.

[75]  P. Olivier,et al.  Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson's disease. , 2014, Gait & posture.

[76]  A. Conneeley Transitions and Brain Injury: A Qualitative Study Exploring the Journey of People with Traumatic Brain Injury , 2012, Brain Impairment.

[77]  J. Giacino,et al.  The vegetative and minimally conscious states: diagnosis, prognosis and treatment. , 2011, Neurologic clinics.

[78]  F. Routhier,et al.  Team Consensus Concerning Important Outcomes for Augmentative and Alternative Communication Assistive Technologies: A Pilot Study , 2013, Augmentative and alternative communication.

[79]  Niels Birbaumer,et al.  Using brain–computer interfaces to overcome the extinction of goal-directed thinking in minimally conscious state patients , 2012, Cognitive Processing.

[80]  Joseph F. Wallace Assistive technology funding in the United States. , 2011, NeuroRehabilitation.

[81]  B. Daveson An audit about music therapy assessments and recommendations for adult patients suspected to be in a low awareness state. , 2010, Journal of music therapy.

[82]  T. Wallace,et al.  Technologies and strategies for people with communication problems following brain injury or stroke. , 2011, NeuroRehabilitation.

[83]  C. V. van Heugten,et al.  Use of assistive technology in cognitive rehabilitation: Exploratory studies of the opinions and expectations of healthcare professionals and potential users , 2012, Brain injury.

[84]  Linda-Jeanne Elsaesser,et al.  Integrating medical, assistive, and universally designed products and technologies: assistive technology device classification (ATDC) , 2012, Disability and rehabilitation. Assistive technology.

[85]  F. Barbone,et al.  The Prevalence of Vegetative and Minimally Conscious States: A Systematic Review and Methodological Appraisal , 2014, The Journal of head trauma rehabilitation.

[86]  H. Karlsson The prevalence of what? , 2009, Nordic journal of psychiatry.

[87]  Nirbhay N. Singh,et al.  Promoting adaptive behavior in persons with acquired brain injury, extensive motor and communication disabilities, and consciousness disorders. , 2012, Research in developmental disabilities.

[88]  Denise M Peters,et al.  Active Video-Gaming Effects on Balance and Mobility in Individuals with Chronic Stroke: A Randomized Controlled Trial , 2013, Topics in stroke rehabilitation.

[89]  Ching-Hsiang Shih,et al.  Assisting patients with disabilities to actively perform occupational activities using battery-free wireless mice to control environmental stimulation. , 2012, Research in developmental disabilities.

[90]  T. Särkämö,et al.  Music listening after stroke: beneficial effects and potential neural mechanisms , 2012, Annals of the New York Academy of Sciences.

[91]  Niels Birbaumer,et al.  Arousal and Attention: Self-chosen Stimulation Optimizes Cortical Excitability and Minimizes Compensatory Effort , 2008, Journal of Cognitive Neuroscience.

[92]  Craig H. Kennedy,et al.  Single-Case Designs for Educational Research , 2004 .

[93]  Nirbhay N. Singh,et al.  Technology-based intervention programs to promote stimulation control and communication in post-coma persons with different levels of disability , 2013, Front. Hum. Neurosci..

[94]  L. Elliott,et al.  Rehabilitation interventions for vegetative and minimally conscious patients , 2005, Neuropsychological rehabilitation.

[95]  Nirbhay N. Singh,et al.  Technology to help persons with extensive neuro-motor impairment and lack of speech with their leisure occupation and communication. , 2014, Research in developmental disabilities.