title: Assessing learning as a possible sign of consciousness in post-coma persons with minimal responsiveness.
abstract: A learning test procedure based on operant principles may be useful in the diagnosis (and eventually rehabilitation) of post-coma persons with minimal responsiveness. This study was aimed at extending the evaluation of such a procedure with seven participants who presented with very limited behavior and apparently severe disorders of consciousness. The procedure was evaluated through an ABACB design, in which A represented baseline phases without stimulation, B intervention phases with brief stimulation periods contingent on specific responses of the participants, and C a control phase in which stimulation was available all the time. Increased responding during the B phases, as opposed to the A and C phases, was taken to indicate learning and possibly a non-reflective expression of phenomenal consciousness. All participants were also evaluated with the coma recovery scale-revised (CRS-R) prior to the start of the learning test procedure and at the end of it. The results of the learning test showed that all participants had significantly higher responding levels during the B phases. The CRS-R scores suggested minimally conscious state for four of them prior to the learning test and for five of them after the completion of the learning test. The implications of the findings are discussed in terms of potential and time cost of the learning test.
authors.affiliation: Department of Neuroscience and Sense Organs, University of Bari Bari, Italy.
authors.forename: Giulio E
authors.initials: GE
authors.lastname: Lancioni
authors.affiliation: Department of Educational Science, Psychology, Communication, University of Bari Bari, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bosco
authors.affiliation: Department of Psychology, University "La Sapienza" Rome, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Olivetti Belardinelli
authors.affiliation: Medical College of Georgia, Georgia Regents University Augusta, GA, USA.
authors.forename: Nirbhay N
authors.initials: NN
authors.lastname: Singh
authors.affiliation: University of Texas at Austin, Austin TX, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: O'Reilly
authors.affiliation: Victoria University of Wellington Wellington, New Zealand.
authors.forename: Jeff
authors.initials: J
authors.lastname: Sigafoos
authors.affiliation: S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Buonocunto
authors.affiliation: S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy.
authors.forename: Jorge
authors.initials: J
authors.lastname: Navarro
authors.affiliation: S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy.
authors.forename: Crocifissa
authors.initials: C
authors.lastname: Lanzilotti
authors.affiliation: S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy.
authors.forename: Fiora
authors.initials: F
authors.lastname: D'Amico
authors.affiliation: Department of Neuroscience and Sense Organs, University of Bari Bari, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: De Tommaso
keywords: learning; microswitches; minimally conscious state; vegetative state