Biomedical Engineering Reference
In-Depth Information
watching pictures, magazines, or video-clips. The intervention initially focused on the use
of the microswitch. Subsequently, the intervention emphasis was on the use of the VOCA.
Eventually, the program alternated sessions with the microswitch and sessions with the
VOCA. The outcome was satisfactory with the man acquiring and maintaining respond-
ing in relation to both the microswitch and the VOCA.
Lancioni et al. (2009c) conducted a study with 11 participants whose ages ranged
between approximately 5 and 18 years. All participants were provided with one micro-
switch and one VOCA. Head, foot and hand movements, and vocalizations constituted
the main types of responses for activating those devices. The intervention started always
with the use of the microswitch. When responding to this had increased, the intervention
focused on the VOCA. Finally, the microswitch and the VOCA were simultaneously avail-
able. The activation of the microswitch allowed the participants a brief access to preferred
stimulation. This varied across participants and included, among other things, vibratory
inputs, musical items, voices and noises, and lights. The activation of the VOCA caused
the emission of a short phrase requesting the attention of the caregiver. The response of
the caregiver could be verbal or verbal and physical (i.e., the same way as in the study
reported above; Lancioni et al. 2008a). Data showed that all participants acquired success-
ful microswitch and VOCA responding. The frequency of microswitch responding was
always higher than the frequency of VOCA responding (i.e., as in the previous study).
Such an outcome could reflect a lower impact of the VOCA consequences, which were
probably softened by the decision to apply only verbal consequences to most participant
requests. The positive implications of the findings are that VOCA requests (1) could be
satisfactorily combined with microswitch use (i.e., independent management of environ-
mental stimulation), and (2) could be maintained via a combination of feedbacks, most of
which (i.e., the verbal responses) were extremely economical and practical to implement
for the caregiver.
Lancioni et al. (2009e) carried out an intervention program with two post-coma indi-
viduals (a man and a woman) of 35 and 60 years of age who were diagnosed to be in a
minimally conscious state and presented with extensive motor disabilities. Both partici-
pants were initially led to use a microswitch, which allowed them to access brief periods
of preferred stimulation (e.g., music). The microswitches consisted of a touch-sensitive
device fixed onto the leg of the man and a touch- and pressure-sensitive device fixed
into the palm of the woman's hand. When they could use the microswitch, the VOCA
was introduced. This consisted of (1) a wobble-like device attached to the stomach of the
man that could be activated by a general hand movement, and (2) tilt devices attached
to the foot of the woman that could be activated through slight foot movement. VOCA
activation produced a call for caregiver attention. In response to the call, the caregiver
talked to and engaged the participant in watching or listening to various stimuli. In the
final phase of the program, the microswitch and the VOCA were simultaneously pres-
ent for each participant. The participants learned to use both forms of technology, thus
increasing their independent access to stimulation and their positive interaction with the
caregiver.
Lancioni et al. (2010d) reported the case of a 20-year-old man who was taught to use
the single versus the repeated execution of simple motor schemes as different responses.
Initially, the intervention focused on establishing a single and a double finger move-
ment as two separate microswitch responses. Those responses were recorded by a touch-
sensitive microswitch and led to different types of video-clips. Then, the intervention
focused on establishing a single and a double head movement as two different VOCA
responses. Those responses were recorded through a pressure-sensitive device placed on
