title: Helping people in a minimally conscious state develop responding and stimulation control through a microswitch-aided program.
abstract: BACKGROUND
  Postcoma persons in a minimally conscious state (MCS) and with extensive motor impairment cannot independently access and control environmental stimulation.
  
  
  OBJECTIVE
  Assessing the effects of a microswitch-aided program aimed at helping MCS persons develop responding and stimulation control and conducting a social validation/evaluation of the program.
  
  
  METHODS
  A single-subject ABAB design was used for each participant to determine the impact of the program on his or her responding. Staff interviews were used for the social validation/evaluation of the program.
  
  
  METHODS
  Rehabilitation and care facilities that the participants attended.
  
  
  METHODS
  Eleven MCS persons with extensive motor impairment and lack of speech or any other functional communication.
  
  
  METHODS
  For each participant, baseline (A) phases were alternated with intervention (B) phases during which the program was used. The program relied on microswitches to monitor participants' specific responses (e.g., prolonged eyelid closures) and on a computer system to enable those responses to control stimulation. In practice, the participants could use a simple response such as prolonged eyelid closure to generate a new stimulation input. Sixty-six staff people took part in the social validation of the program. They were to compare the program to basic and elaborate forms of externally controlled stimulation, scoring each of them on a six-item questionnaire.
  
  
  RESULTS
  All participants showed increased response frequencies (and thus higher levels of independent stimulation input/control) during the B phases of the study. Their frequencies for each intervention phase more than doubled their frequencies for the preceding baseline phase with the difference between the two being clearly significant (P<0.01). Staff involved in the social validation procedure provided significantly higher scoring (P<0.01) for the program on five of the six questionnaire items.
  
  
  CONCLUSIONS
  A microswitch-aided program can be an effective and socially acceptable tool in the work with MCS persons.
  
  
  CONCLUSIONS
  The participants and staff's data can be taken as an encouragement for the use of a microswitch-aided program within care and rehabilitation settings for MCS persons.
authors: Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy - giulio.lancioni@uniba.it.
authors: Giulio E
authors: GE
authors: Lancioni
authors: Medical College of Georgia, Augusta University, Augusta, GA, USA.
authors: Nirbhay N
authors: NN
authors: Singh
authors: Department of Special Education, University of Texas, Austin, TX, USA.
authors: Mark F
authors: MF
authors: O'Reilly
authors: School of Education, Victoria University of Wellington, Wellington, New Zealand.
authors: Jeff
authors: J
authors: Sigafoos
authors: Lega F. D'Oro Research Center, Osimo, Ancona, Italy.|S. Raffaele Care Center, Alberobello, Bari, Italy.
authors: Fiora
authors: F
authors: D'Amico
authors: S. Raffaele Rehabilitation Center, Ceglie, Brindisi, Italy.
authors: Francesca
authors: F
authors: Buonocunto
authors: S. Raffaele Rehabilitation Center, Ceglie, Brindisi, Italy.
authors: Jorge
authors: J
authors: Navarro
authors: S. Raffaele Rehabilitation Center, Ceglie, Brindisi, Italy.
authors: Crocifissa
authors: C
authors: Lanzilotti
authors: Department of Physical and Rehabilitation Medicine, Polyclinic of Bari, Bari, Italy.
authors: Pietro
authors: P
authors: Fiore
authors: Department of Physical and Rehabilitation Medicine, Polyclinic of Bari, Bari, Italy.
authors: Marisa
authors: M
authors: Megna
authors: Department of Physical and Rehabilitation Medicine, Polyclinic of Bari, Bari, Italy.
authors: Sabino
authors: S
authors: Damiani
authors: Department of Physical and Rehabilitation Medicine, Polyclinic of Bari, Bari, Italy.
authors: Riccardo
authors: R
authors: Marvulli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003143:Communication Devices for People with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D055616:Microtechnology; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D011597:Psychomotor Performance; D015203:Reproducibility of Results