Biomedical Engineering Reference
In-Depth Information
as contact with the caregivers, and (2) required the caregivers a level of commitment and
responsibility presumably compatible with other daily duties (i.e., much more practicable
than direct interaction with the participant or consistent availability within a program
based exclusively on the use of VOCA devices) (Lancioni et al. 2008a, 2008c, 2008d, 2009b,
2009c, 2009e, 2009f, 2010d).
For example, Lancioni et al. (2008a) reported a program carried out with a 30-year-old
man who was in a minimally conscious state and suffered extensive neuromotor dis-
abilities after traumatic brain injury and coma. Initially, the man was provided with a
microswitch, which allowed him to access brief periods of video-images. The microswitch
consisted of touch sensors attached to the index finger of the right hand and activated
by small movements/contacts of the thumb of the same hand. Then a VOCA device was
introduced. The VOCA consisted of a sound-detecting sensor using a throat microphone
and an airborne microphone. Activation of the sensor led to the occurrence of verbal mes-
sages (requests of interaction) directed to the man's mother or the man's sister depending
on the length of the vocalization response. The mother and the sister could respond by
presenting highly preferred items or low-impact items. Eventually, the microswitch and
the VOCA were simultaneously available. The man learned to use the microswitch and the
VOCA. Indeed, he used the VOCA to preferentially call the mother or the sister depending
upon the stimuli that they offered. He also continued to use those instruments success-
fully during the last part of the study when they were simultaneously available.
Lancioni et al. (2008c) arranged a program, which included two microswitches and a
VOCA for two participants of 16 and 18 years of age. The responses selected for the micro-
switches consisted of head and hand movements for both participants. The responses
selected for the VOCA consisted of vocalization for one participant and a specific hand
movement for the other participant. Initially, the intervention focused on each of the two
microswitches individually. When responding had increased, they were made available
simultaneously. Subsequently, the intervention focused on the VOCA. Once responding
to it had increased, the VOCA and the two microswitches were made available simul-
taneously. The participants could choose among the three opportunities. Activation of
the microswitches allowed the participants to access different sets of preferred stimuli
(e.g., musical and visual items). Activation of the VOCA triggered a vocal output apparatus,
which emitted a short phrase that requested for the attention of the caregiver. The care-
giver responded to the requests in different ways (i.e., only verbally or verbally and physi-
cally). The verbal responses consisted of complimentary/support sentences and occurred
for about two-thirds of the VOCA requests. The verbal and physical responses consisted
of talking to and touching/caressing or kissing the participant briefly and occurred for
about one-third of the VOCA requests. The use of the two types of responses was based
on practical considerations. The verbal responses could also be easily administered dur-
ing caregiver engagement in other duties. The outcome of the study was positive for both
participants. They learned to use the microswitches and the VOCA. Nearly three-fourths
of their total responses were directed to the microswitches and about one-fourth were
related to the VOCA.
Lancioni et al. (2009b) implemented a program involving the use of a microswitch and
a VOCA with a post-coma man of 52 years of age. The man had a diagnosis of minimally
conscious state and extensive neuromotor disabilities. The responses required for activat-
ing the two devices were head movements and arm movements, respectively. Microswitch
activations allowed the participant to have brief exposures to recordings of comic sketches.
VOCA activations (triggering a verbal call for the caregiver) were followed by the care-
giver approaching the man, talking to him, and engaging him briefly in activities such as
