Abstract
These two studies were aimed at replicating and extending previous research on the use of microswitch-aided intervention for persons in a minimally conscious state (MCS). Study 1 was a new assessment of the effectiveness of such intervention in helping MCS persons increase functional responding to control environmental stimulation. Ten participants were included. Study 2 compared the effects of microswitch-aided intervention with the effects of typical environmental stimulation strategies on participants’ alertness and involvement (i.e., on keeping eyes open and/or displaying body movements). Eight of the ten participants of study 1 were involved in study 2. The results of study 1 confirmed the suitability of microswitch-aided intervention for promoting adaptive/functional responding and stimulation control in MCS persons. The results of study 2 showed that microswitch-aided intervention may have advantages over basic and elaborate stimulation strategies in terms of participants’ alertness and involvement. Based on the results of the two studies, microswitch-aided intervention might be considered a practical tool for helping MCS persons.
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References
Abbate, C., Trimarchi, P. D., Basile, I., Mazzucchi, A., & Devalle, G. (2014). Sensory stimulation for patients with disorders of consciousness: from stimulation to rehabilitation. Frontiers in Human Neuroscience, 8, 616. https://doi.org/10.3389/fnhum.2014.00616.
Angelakis, E., Liouta, E., Andreadis, N., Korfias, P., Stranialis, G., & Sakas, D. E. (2014). Transcranial direct current stimulation (tDCS) effects in disorders of consciousness. Archieves of Physical Medicine and Rehabilitation, 95, 283–289. https://doi.org/10.1016/j.apmr.2013.09.002.
Barlow, D. H., Nock, M., & Hersen, M. (2009). Single-case experimental designs: strategies for studying behavior change (3rd ed.). New York: Allyn & Bacon.
Bekinschtein, T. A., Shalom, D. E., Forcato, C., Herrera, M., Coleman, M. R., Manes, F. F., et al. (2009). Classical conditioning in the vegetative and minimally conscious state. Nature Neuroscience, 12, 1343–1349. https://doi.org/10.1038/nn.2391.
Brandt, M. J., Ijzerman, H., Dijksterhuis, A., Farach, F. J., Geller, J., Giner-Sorolla, R., et al. (2014). The replication recipe: what makes for a convincing replication? Journal of Experimental Social Psychology, 50, 217–224. https://doi.org/10.1016/j.jesp.2013.10.005.
Bruno, M. A., Vanhaudenhuyse, A., Thibaut, A., Moonen, G., & Laureys, S. (2011). From unresponsive wakefulness to minimally conscious PLUS and functional looked-in syndromes: recent advances in our understanding of disorders of consciousness. Journal of Neurology, 258, 1373–1384. https://doi.org/10.1007/s00415-011-6114-x.
Catania, A. C. (2012). Learning (5th ed.). New York: Sloan.
Chervyakov, A. V., Chernyavsky, A. Y., Sinitsyn, D. O., & Piradov, M. A. (2015). Possible mechanisms underlying the therapeutic effects of transcranial magnetic stimulation. Frontiers in Human Neuroscience, 9, 303. https://doi.org/10.3389/fnhum.2015.00303.
Daveson, B. (2010). An audit about music therapy assessments and recommendations for adult patients suspected to be in a low awareness state. Journal of Music Therapy, 47, 408–422.
Di Stefano, C., Cortesi, A., Masotti, S., Simoncini, L., & Piperno, R. (2012). Increased behavioural responsiveness with complex stimulation in VS and MCS: preliminary results. Brain Injury, 26, 1250–1256. https://doi.org/10.3109/02699052.2012.667588.
Dolce, G., Arcuri, F., Carozzo, S., Cortese, M. D., Greco, P., Lucca, L. F., et al. (2015). Care and neurorehabilitation in the disorder of consciousness: a model in progress. Scientific World Journal. https://doi.org/10.1155/2015/463829.
Fischer, T., Langner, R., Birbaumer, N., & Brocke, B. (2008). Arousal and attention: self-chosen stimulation optimizes cortical excitability and minimizes compensatory effort. Journal of Cognitive Neuroscience, 20, 1443–1453. https://doi.org/10.1162/jocn.2008.20101.
Georgiopoulos, M., Katsakiori, P., Kefalopoulou, Z., Ellul, J., Chroni, E., & Constantoyannis, C. (2010). Vegetative state and minimally conscious state: a review of the therapeutic interventions. Stereotactic and Functional Neurosurgery, 88, 199–207.
Giacino, J. T. (1996). Sensory stimulation: theoretical perspectives and the evidence for effectiveness. NeuroRehabilitation, 6, 69–78. https://doi.org/10.3233/NRE-1996-6108.
Giacino, J. T., Fins, J. J., Laureys, S., & Schiff, N. D. (2014). Disorders of consciousness after acquired brain injury: the state of the science. Nature Review Neurology, 10, 99–114. https://doi.org/10.1038/nrneurol.2013.279.
Guerra, A., Costantini, E. M., Maatta, S., Ponzo, D., & Ferreri, F. (2014). Disorders of consciousness and electrophysiological treatment strategies: a review of the literature and new perspectives. Current Pharmaceutical Design, 20, 4248–4267. https://doi.org/10.2174/13816128113196660648.
Hirschberg, R., & Giacino, J. T. (2011). The vegetative and minimally conscious states: diagnosis, prognosis and treatment. Neurologic Clinics, 29, 773–786. https://doi.org/10.1016/j.ncl.2011.07.009.
Kalmar, K., & Giacino, J. T. (2005). The JFK coma recovery scale-revised. Neuropsychological Rehabilitation, 15, 454–460. https://doi.org/10.1080/09602010443000425.
Kazdin, A. E. (2011). Single-case research designs: methods for clinical and applied settings (2th ed.). New York: Oxford University Press.
Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Buonocunto, F., Sacco, V., Colonna, F., et al. (2009). Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state. Developmental Neurorehabilitation, 12, 411–420. https://doi.org/10.3109/17518420903200581.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Amenduni, M. T., Navarro, J., et al. (2012). Microswitch technology and contingent stimulation to promote adaptive engagement in persons with minimally conscious state: a case evaluation. Cognitive Processing, 13, 133–137. https://doi.org/10.1007/s10339-011-0428-6.
Lancioni, G. E., Sigafoos, J., O’Reilly, M. F., & Singh, N. N. (2013). Assistive technology: interventions for individuals with severe/profound and multiple disabilities. New York: Springer.
Lancioni, G. E., Bosco, A., Olivetti Belardinelli, M., Singh, N. N., O’Reilly, M. F., Sigafoos, J., et al. (2014a). Technology-based intervention programs to promote stimulation control and communication in post-coma persons with different levels of disability. Frontiers in Human Neuroscience, 8, 48. https://doi.org/10.3389/fnhum.2014.00048.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Green, V. A., Buonocunto, F., Sacco, V., et al. (2014b). Microswitch-aided programs with contingent stimulation versus general stimulation programs for post-coma persons with multiple disabilities. Developmental Neurorehabilitation, 17, 251–258. https://doi.org/10.3109/17518423.2013.793751.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., D’Amico, F., Buonocunto, F., et al. (2015). Assistive technology to help persons in a minimally conscious state develop responding and stimulation control: Performance assessment and social rating. NeuroRehabilitation, 37, 393–403. https://doi.org/10.3233/NRE-151269.
Lancioni, G. E., Bosco, A., O’Reilly, M. F., Sigafoos, J., & Olivetti Belardinelli, M. (2017a). Assessment and intervention with patients with severe disorders of consciousness. Advances in Neurodevelopmental Disorders, 1, 196–102. https://doi.org/10.1007/s41252-017-0025-5.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., D’Amico, F., Buonocunto, F., et al. (2017b). Helping people in a minimally conscious state develop responding and stimulation control through a microswitch-aided program. European Journal of Physical and Rehabilitation Medicine, 53, 433–440. https://doi.org/10.23736/S1973-9087.16.04324-0.
Lenker, J. A., Harris, F., Taugher, M., & Smith, R. O. (2013). Consumer perspectives on assistive technology outcomes. Disability and Rehabilitation: Assistive Technology, 8, 373–380. https://doi.org/10.3109/17483107.2012.749429.
Lopez-Rolon, A. (2017). Severe disorders of consciousness after acquired brain injury: a single-centre long-term follow-up study. NeuroRehabilitation. https://doi.org/10.3233/NRE-171438.
Lotze, M., Schertel, K., Birbaumer, N., & Kotchoubey, B. (2011). A long- term intensive behavioral treatment study in patients with persistent vegetative state or minimally conscious state. Journal of Rehabilitation Medicine, 43, 230–236. https://doi.org/10.2340/16501977-0653.
Magee, W. L., & O’Kelly, J. (2015). Music therapy with disorders of consciousness: current evidence and emergent evidence-based practice. Annals of the New York Academy of Sciences, 1337, 256–262. https://doi.org/10.1111/nyas.12633.
Magee, W. L., Tillman, B., Perrin, F., & Schnakers, C. (2016). Editorial: music and disorders of consciousness: emerging research, practice and theory. Frontiers in Psychology, 7, 1273. https://doi.org/10.3389/fpsyg.2016.01273.
Makel, M. C., & Plucker, J. A. (2014). Facts are more important than novelty: replication in the education sciences. Educational Researcher, 43, 304–316. https://doi.org/10.3102/0013189X14545513.
Manganotti, P., Formaggio, E., Storti, S. F., Fiaschi, A., Battistin, L., Tonin, P., et al. (2013). Effect of high-frequency repetitive transcranial magnetic stimulation on brain excitability in severely brain-injured patients in minimally conscious or vegetative state. Brain Stimulation, 6, 913–921. https://doi.org/10.1016/j.brs.2013.06.006.
McNamee, S., Howe, L., Nakase-Richardson, R., & Peterson, M. (2012). Treatment of disorders of consciousness in the Veterans Health Administration polytrauma centers. The Journal of Head Trauma Rehabilitation, 27, 244–252. https://doi.org/10.1097/HTR.0b013e31825e12c8.
Munde, V., & Vlaskamp, C. (2015). Initiation of activities and alertness in individuals with profound intellectual and multiple disabilities. Journal of Intellectual Disability Research, 59, 284–292. https://doi.org/10.1111/jir.12138.
Munde, V. S., Vlaskamp, C., Ruijssenaars, A. J. J. M., & Nakken, H. (2009). Alertness in individuals with profound intellectual and multiple disabilities: a literature review. Research in Developmental Disabilities, 30, 462–480. https://doi.org/10.1016/j.ridd.2008.07.003.
Naro, A., Calabrò, R. S., Russo, M., Leo, A., Pollicino, P., Quartarone, A., et al. (2015). Can transcranial direct current stimulation be useful in differentiating unresponsive wakefulness syndrome from minimally conscious state patients? Restorative Neurology and Neuroscience, 33, 159–176. https://doi.org/10.3233/RNN-140448.
Naro, A., Russo, M., Leo, A., Cannavò, A., Manuli, A., Bramanti, A., et al. (2016). Cortical connectivity modulation induced by cerebellar oscillatory transcranial direct current stimulation in patients with chronic disorders of consciousness: a marker of covert cognition? Clinical Neurophysiology, 127, 1845–1854. https://doi.org/10.1016/j.clinph.2015.12.010.
O’Kelly, J., James, L., Palaniappan, R., Taborin, J., Fachner, J., & Magee, W. L. (2013). Neurophysiological and behavioral responses to music therapy in vegetative and minimally conscious states. Frontiers in Human Neuroscience, 7, 884. https://doi.org/10.3389/fnhum.2013.00884.
Padilla, R., & Domina, A. (2016). Effectiveness of sensory stimulation to improve arousal and alertness of people in a coma or persistent vegetative state after traumatic brain injury: a systematic review. American Journal of Occupational Therapy, 70, 7003180030p1-8. https://doi.org/10.5014/ajot.2016.021022.
Pape, T. L. B., Rosenow, J., Lewis, G., Ahmed, G., Walker, M., Guernon, A., et al. (2009). Repetitive transcranial magnetic stimulation-associated neurobehavioral gains during coma recovery. Brain Stimulation, 2, 22–35. https://doi.org/10.1016/j.brs.2008.09.004.
Pape, T. L. B., Rosenow, J. M., Harton, B. S., Patil, V., Guernon, A., Parrish, T., et al. (2012). Preliminary framework for Familiar Auditory Sensory Training (FAST) provided during coma recovery. Journal of Rehabilitation Research and Development, 49, 1137–1152. https://doi.org/10.1682/JRRD.2011.08.0154.
Pape, T. L. B., Rosenow, J., Steiner, M., Parrish, T., Guernon, A., Harton, B., et al. (2015). Placebo-controlled trial of familiar auditory sensory training for acute severe traumatic brain injury: a preliminary report. Neurorehabilitation and Neural Repair, 29, 537–547. https://doi.org/10.1177/1545968314554626.
Pedhazur, E., & Schmelkin, L. (1991). Measurement design and analysis: an integrated approach. New York: Psychology Press.
Piccione, F., Cavinato, M., Manganotti, P., Formaggio, E., Storti, S. F., Battistin, L., et al. (2011). Behavioral and neurophysiological effects of repetitive transcranial magnetic stimulation on the minimally conscious state: a case study. Neurorehabilitation and Neural Repair, 25, 98–102. https://doi.org/10.1177/1545968310369802.
Pierce, W. D., & Cheney, C. D. (2008). Behavior analysis and learning (4th ed.). New York: Psychology Press.
Pignat, J. M., Mauron, E., Jöhr, J., Gilart de Keranflec’h, C., Van De Ville, D., Preti, M. G., et al. (2016). Outcome prediction of consciousness disorders in the acute stage based on the complementary motor behavioural tool. PLoS One, 11, e0156882. https://doi.org/10.1371/journal.pone.0156882.
Pisani, L. R., Naro, A., Leo, A., Aricò, I., Pisani, F., Silvestri, R., et al. (2015). Repetive transcranial magnetic stimulation induced slow wave activity modification: a possible role in disorders of consciousness differential diagnosis? Consciousness and Cognition, 38. https://doi.org/10.1016/j.concog.2015.09.012.
Polit, D. F., & Beck, C. T. (2010). Generalization in quantitative and qualitative research: myths and strategies. International Journal of Nursing Studies, 47, 1451–1458. https://doi.org/10.1016/j.ijnurstu.2010.06.004.
Riganello, F., Cortese, M. D., Dolce, G., & Sannita, W. G. (2013). Visual pursuit response in the severe disorder of consciousness: modulation by the central automatic system and a predictive model. BMC Neurology, 13, 164. https://doi.org/10.1186/1471-2377-13-164.
Roche, L., Sigafoos, J., Lancioni, G. E., O’Reilly, M. F., & Green, V. A. (2015). Microswitch technology for enabling self-determined responding in children with profound and multiple disabilities: a systematic review. Augmentative and Alternative Communication, 31, 246–258. https://doi.org/10.3109/07434618.2015.1024888.
Siegel, S., & Castellan, N. J. (1988). Nonparametric statistics for the behavioral sciences (2nd ed.). New York: McGraw-Hill.
Thibaut, A., Bruno, M. A., Ledoux, D., Demertzi, A., & Laureys, S. (2014). tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study. Neurology, 82, 1112–1118.
Thibaut, A., Wannez, S., Donneau, A. F., Chatelle, C., Gosseries, O., Bruno, M. A., et al. (2017). Controlled clinical trial of repeated prefrontal tDCS in patients with chronic minimally conscious state. Brain Injury. https://doi.org/10.1080/02699052.2016.1274776.
Wallace, T., & Bradshaw, A. (2011). Technologies and strategies for people with communication problems following brain injury or stroke. NeuroRehabilitation, 28, 199–209. https://doi.org/10.3233/NRE-2011-0649.
Whyte, J. (2007). Treatments to enhance recovery from the vegetative and minimally conscious states. American Journal of Physical Medicine and Rehabilitation, 86, 86–92. https://doi.org/10.1097/PHM.0b013e31802f0434.
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GL was responsible for setting up the study, acquiring and analyzing the data, and writing the manuscript. MO, JS, FD, FB, GD, PT, JN, and CL collaborated in setting up the study and/or analyzing the data, and writing/editing the manuscript.
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The studies were approved by institutional Ethics Committees. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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The participants’ legal representatives had provided written informed consent for their involvement in study 1 and study 2.
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Lancioni, G.E., O’Reilly, M.F., Sigafoos, J. et al. A Further Evaluation of Microswitch-Aided Intervention for Fostering Responding and Stimulation Control in Persons in a Minimally Conscious State. Adv Neurodev Disord 2, 322–331 (2018). https://doi.org/10.1007/s41252-018-0064-6
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DOI: https://doi.org/10.1007/s41252-018-0064-6