RESUMO
BACKGROUND: Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated. OBJECTIVE: This study aimed to (a) further assess a technology-aided approach for fostering MCS participants' responding and stimulation control and (b) carry out a social validation check about the approach. METHODS: Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check. RESULTS: The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants. CONCLUSIONS: A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.
Assuntos
Estado Vegetativo Persistente/psicologia , Estado Vegetativo Persistente/reabilitação , Desempenho Psicomotor , Tecnologia Assistiva , Comportamento Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Coma/etiologia , Coma/psicologia , Auxiliares de Comunicação para Pessoas com Deficiência , Meio Ambiente , Pálpebras , Feminino , Dedos , Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fala , Distúrbios da Fala/etiologia , Distúrbios da Fala/reabilitação , Resultado do Tratamento , Adulto JovemRESUMO
Intervention programs for people with acquired brain injury and extensive motor and communication impairment need to be diversified according to their characteristics and environment. These two studies assessed two technology-aided programs for supporting leisure (i.e., access to songs and videos) and communication (i.e., expressing needs and feelings and making requests) in six of those people. The three people participating in Study 1 did not possess speech but were able to understand spoken and written sentences. Their program presented leisure and communication options through written phrases appearing on the computer screen. The three people participating in Study 2 did not possess any speech and were unable to understand spoken or written language. Their program presented leisure and communication options through pictorial images. All participants relied on a simple microswitch response to enter the options and activate songs, videos, and communication messages. The data showed that the participants of both studies learned to use the program available to them and to engage in leisure and communication independently. The importance of using programs adapted to the participants and their environment was discussed.
Assuntos
Dano Encefálico Crônico/psicologia , Dano Encefálico Crônico/reabilitação , Lesão Encefálica Crônica/psicologia , Lesão Encefálica Crônica/reabilitação , Transtornos da Comunicação/psicologia , Transtornos da Comunicação/reabilitação , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Atividades de Lazer , Tecnologia Assistiva , Avaliação da Tecnologia Biomédica , Adulto , Idoso , Idoso de 80 Anos ou mais , Afasia/psicologia , Afasia/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SoftwareRESUMO
These two studies extended the evidence on the use of technology-based intervention packages to promote adaptive behavior in persons with acquired brain injury and multiple disabilities. Study I involved five participants in a minimally conscious state who were provided with intervention packages based on specific arrangements of optic, tilt, or pressure microswitches (linked to preferred environmental stimuli) and eyelid, toe and finger responses. Study II involved three participants who were emerging from a minimally conscious state and were provided with intervention packages based on computer presentations of stimulus options (i.e., preferred stimuli, functional caregiver's procedures, and non-preferred stimuli) and pressure microswitches to choose among them. Intervention data of Study I showed that the participants acquired relatively high levels of microswitch responding (thus engaging widely with preferred environmental stimuli) and kept that responding consistent except for one case. Intervention data of Study II showed that the participants were active in choosing among preferred stimuli and positive caregivers' procedures, but generally abstained from non-preferred stimuli. The results were discussed in terms of the successful use of fairly new/infrequent microswitch-response arrangements (Study I) and the profitable inclusion of functional caregiver's procedures among the options available to choice (Study II).
Assuntos
Adaptação Psicológica , Dano Encefálico Crônico/reabilitação , Lesão Encefálica Crônica/reabilitação , Auxiliares de Comunicação para Pessoas com Deficiência , Transtornos da Comunicação/reabilitação , Promoção da Saúde , Estado Vegetativo Persistente/reabilitação , Transtornos Psicomotores/reabilitação , Terapia Assistida por Computador/métodos , Adulto , Idoso , Nível de Alerta , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/psicologia , Lesão Encefálica Crônica/diagnóstico , Lesão Encefálica Crônica/psicologia , Comportamento de Escolha , Transtornos da Comunicação/diagnóstico , Transtornos da Comunicação/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Exame Neurológico , Estado Vegetativo Persistente/diagnóstico , Estado Vegetativo Persistente/psicologia , Transtornos Psicomotores/diagnóstico , Transtornos Psicomotores/psicologia , Centros de Reabilitação , Autocuidado/psicologia , Terapia Assistida por Computador/instrumentaçãoRESUMO
OBJECTIVE: Evaluating a learning assessment procedure for monitoring progress with two post-coma adults with a diagnosis of vegetative state. METHOD: ABABCBCB and ABABCB designs were used for the two participants, with A representing baseline, B intervention and C control conditions. Participants' activation of an optic microswitch by eyelid closure produced stimulation during B phases. RESULTS: One participant increased responding during B phases and decreased it during the C condition, suggesting a non-reflective minimal level of consciousness. She showed P300 and mismatch negativity responses and scored at the vegetative level on the Coma Recovery Scale-Revised (CRS-R). The other participant increased responding during the initial B phases without decline during the first (viable) part of the C condition, suggesting a pre-conscious level. He showed indistinct P300 and mismatch negativity responses and vegetative-level scores on the CRS-R. CONCLUSION: Learning data seemed reconcilable with neurophysiological measures and more positive than CRS-R scores.
Assuntos
Encéfalo/fisiopatologia , Estado de Consciência/fisiologia , Aprendizagem/fisiologia , Estado Vegetativo Persistente/diagnóstico , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/fisiopatologiaRESUMO
Post-coma persons in an apparent condition of vegetative state and pervasive motor impairment pose serious problems in terms of assessment and intervention options. A technology-based learning assessment procedure might serve for them as a diagnostic supplement with possible implications for rehabilitation intervention. The learning assessment procedure adopted in this study relied on hand-closure and eye-blinking responses and on microswitch technology to detect such responses and to present stimuli. Three participants were involved in the study. The technology consisted of a touch/pressure sensor fixed on the hand or an optic sensor mounted on an eyeglasses' frame, which were combined with a control system linked to stimulus sources. The study adopted an ABABCB sequence, in which A represented baseline periods, B intervention periods with stimuli contingent on the responses, and C a control condition with stimuli presented non-contingently. Data showed that the level of responding during the B phases was significantly higher than the levels observed during the A phases as well as the C phase for two of the three participants (i.e., indicating clear signs of learning by them). Learning might be deemed to represent basic levels of knowledge/consciousness. Thus, detecting signs of learning might help one revise a previous diagnosis of vegetative state with wide implications for rehabilitation perspectives.
Assuntos
Coma/complicações , Estado Vegetativo Persistente/diagnóstico , Tecnologia Assistiva , Adulto , Idoso , Piscadela , Lesões Encefálicas/reabilitação , Auxiliares de Comunicação para Pessoas com Deficiência , Feminino , Força da Mão , Humanos , Masculino , Terapia Ocupacional/instrumentação , Estado Vegetativo Persistente/etiologia , Estado Vegetativo Persistente/reabilitação , Desempenho PsicomotorRESUMO
PRIMARY OBJECTIVE: Detecting signs of learning in persons with a diagnosis of post-coma vegetative state and profound motor disabilities could modify their diagnostic label and provide new hopes. In this study, three adults with such a diagnosis were exposed to learning assessment to search for those signs. PROCEDURE AND DESIGN: The assessment procedure relied on participants' eye-blinking responses and microswitch-based technology. The technology consisted of an electronically regulated optic microswitch mounted on an eyeglasses' frame that the participants wore during the study and an electronic control system connected to stimulus sources. Each participant followed an ABABCB design, in which A represented baseline periods, B intervention periods with stimuli contingent on the responses and C a control condition with stimuli presented non-contingently. MAIN OUTCOMES AND RESULTS: The level of responding during the B phases was significantly higher than the levels observed during the A phases as well as the C phase for all participants (i.e. indicating clear signs of learning by them). CONCLUSIONS: These findings may have important implications for (a) changing the participants' diagnostic label and offering them new programme opportunities and (b) including learning assessment within the evaluation package used for persons with post-coma profound multiple disabilities.
Assuntos
Piscadela/fisiologia , Coma/reabilitação , Estado Vegetativo Persistente/reabilitação , Pessoas com Deficiência Mental/reabilitação , Adulto , Idoso , Aprendizagem por Associação , Coma/diagnóstico , Coma/fisiopatologia , Auxiliares de Comunicação para Pessoas com Deficiência , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Estado Vegetativo Persistente/diagnóstico , Estado Vegetativo Persistente/fisiopatologia , Pessoas com Deficiência Mental/psicologia , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To evaluate the viability of technology-assisted learning setups for undertaking assessment and providing intervention to persons in vegetative state. METHOD: Study I investigated whether three persons with a diagnosis of vegetative state could associate eye blinking or hand closure responses with contingent, positive stimulation, thus increasing their frequencies (showing signs of learning). Study II extended the learning process (introducing a new response and new stimuli) for one of the participants of Study I. RESULTS: Two of the participants of Study I succeeded in increasing their responses, indicating signs of learning. Study II showed that the participant (one of the two succeeding in Study I) acquired a new response to access new stimuli and could alternate this response with the one acquired in Study I. CONCLUSION: Learning might represent a basic level of knowledge and consciousness. Detecting signs of learning might help modify a previous diagnosis of vegetative state and support intervention/rehabilitation efforts.