title: 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.
abstract: OBJECTIVE
  Thirteen (10 males) participants with severe acquired brain injuries (ABI) were randomly assigned to two treatments, A or B (ABAB, BABA) in a crossover study to determine which treatment approach elicited more consistent and reliable yes/no responses.
  
  
  METHODS
  Treatment A consisted of an enriched stimulus environment, collaborative multidisciplinary interventions and additional yes/no response training, while Treatment B consisted of the standard hospital environment and interventions.
  
  
  RESULTS
  An ANOVA showed no order effect (AB vs BA; p=0.60), but a trend (A vs B;p=0.07) towards statistical significance for increased responsiveness with treatment A. Inter-raterreliability (n=10) ranged from fair-to-good, intra class correlation (ICC) 0.51; 95% confidence interval (CI) (0.29-0.93). Post-hoc analyses showed statistically significant increased responsiveness for four participants with treatment A (p<0.001).
  
  
  CONCLUSIONS
  Evidence is provided that enhanced communication strategies can improve responsiveness in a sub-group of participants with severe acquired brain injuries.
authors.affiliation: Adult Specialized Rehabilitation Services, Hamilton Health Sciences, Hamilton, Ontario, Canada. barreca@hhsc.ca
authors.forename: Susan
authors.initials: S
authors.lastname: Barreca
authors.forename: Diana
authors.initials: D
authors.lastname: Velikonja
authors.forename: Lynn
authors.initials: L
authors.lastname: Brown
authors.forename: Lynne
authors.initials: L
authors.lastname: Williams
authors.forename: Lori
authors.initials: L
authors.lastname: Davis
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Sigouin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D020208:Brain Injury, Chronic / Q000523:psychology / Q000534:rehabilitation*; D003142:Communication; D018592:Cross-Over Studies; D003463:Cues; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016896:Treatment Outcome