Two persons with severe post-coma motor impairment and minimally conscious state use assistive technology to access stimulus events and social contact

Arranging and testing environmental/behavioral (i.e., non-medical) intervention programs for persons with severe post-coma motor impairment and minimally conscious state can be very challenging, and the experimental evidence available in the area is fairly limited [1–5]. Two environmental/behavioral intervention strategies, which might be used as a guide in this process, rely on general sensory stimulation and learning principles combined with assistive technology, respectively [1,2,5–9]. The first strategy rests on the notion that sensory stimulation may enhance recovery from brain injury, may reduce the risk of sensory deprivation that is highly likely in persons who have limited contact with the outside world, and may promote alertness while counteracting low arousal and withdrawal phenomena [5,10,11]. Sensory stimulation may occur through daily sessions involving the presentation of orientation cues and commands, general noises, familiar voices, radio and television clips, lights, vibrotactile inputs, or odors [5,12,13]. The second strategy relies on the notion that a learning setup and assistive technology might be used to help the person acquire/consolidate simple responses instrumental to access specific (preferred) environmental stimulation and positive human contact [14–17]. The expectation is to build an association between the responses and their positive effects (i.e., to enable the person to acquire some awareness of the link between his or her behavior and the immediate environment and thus enhance his or her level of consciousness and functional engagement) [15]. The latter strategy may be considered quite adequate in enriching the stimulation input, promoting an active role for the person, increasing his or her level of performance, and possibly developing his or her control of behavior and environmental events and ultimately his communication. The same strategy can also be easily adjusted (extended) over time to suit the person’s progress and emphasize his or her improving social image [15,18]. In spite of these positive aspects, the use of this strategy has been minimal and the need for new application efforts is clear [19,20]. This study was one such effort. It assessed a program based on the use of learning principles and assistive technology with two persons with a diagnosis of severe post-coma motor impairment and minimally conscious state. The program was intended to help the persons bring about brief periods of environmental stimulation through a microswitch and request contact with the caregiver through a voice output communication aid (VOCA). The microswitch and the VOCA were introduced in sequence and eventually were made simultaneously available so that the participants could decide (choose) about their use.