Lancioni, G.

O'Reilly, M.

OLIVETTI, Marta

Sigafoos, J.

Singh, N.

English

Archivio della ricerca- Università di Roma La Sapienza

lEttErs to thE Editor  594 EuropEaN JourNal of physical aNd rEhabilitatioN MEdiciNE august 2016to be passive and isolated. recently, technology-aided behav-ioral programs have been arranged to help these persons improve their situation and preliminary data are promising.1, 2 the pro-grams rely on computer systems to regulate the presentation of various stimulation and choice options, and microswitches (sen-sors) to help the participants deal with those options with minimal responses. Six basic program levels can be identified from the studies conducted in this area. The first four levels concern MCS participants and the last two levels participants emerged from a Mcs with receptive language skills.first level: the program allows the participant to access a set of preferred stimuli (e.g., music) through a simple response.1 the par-ticipant is provided with a microswitch (e.g., an optic or pressure device) that he or she can activate with a response such as finger movement or eyelid closure. Each response occurrence is followed by a brief activation of the preferred stimuli. acquisition of the link between response and stimuli enables the participant to gain control over the stimuli and have an active role in deciding his or her level of sensory input, with advances in response engagement, alertness/attention, and social status.3second level: the program allows the participant to access two different sets of preferred stimuli through two responses.1 the participant is initially provided with one microswitch suit-able for a specific/simple response to access the stimuli of the first set. subsequently, the participant is provided with a second microswitch for a second response to access the stimuli of the other set. Eventually, the participant (a) alternates the use of the two microswitches in separate sessions so as to practice each response and access each set of stimuli regularly or (b) has both microswitches simultaneously to choose between stimuli and responses freely.third level: the program allows the participant to access pre-ferred stimuli and request for caregiver attention.4 the participant is initially provided with a microswitch to access preferred stimuli. then, he or she is provided with a second microswitch whose ac-tivation leads the computer to emit a verbal request for caregiver attention. Eventually, both microswitches are available simultane-ously so that the participant can choose between specific stimuli and caregiver attention freely.fourth level: the program allows the participant to choose within groups of stimuli.2 the computer presents brief samples of the single stimuli. in relation to each sample, the participant can perform a positive choice response (i.e., by activating the micro-switch available) or a negative choice response (i.e., by abstaining from microswitch activation). a positive choice response leads the computer to present a segment of the sample-related stimulus. at the end of the segment, the participant can choose an extension in the presentation of that stimulus, by new microswitch activation. a negative choice response leads the computer to present the next stimulus sample of the sequence.fifth level: the program allows the participant to commu-nicate via text messages,4 that is, to select and send messages to preferred partners and also receive messages and have them read out by the computer. the sequence to select/send a mes-sage begins with the computer listing the names of the partners. When the participant selects a partner (by activating the micro-switch after his or her name), the computer lists the messages available for that partner (e.g., “how are the children?”, and “i the breeding ground and facilitates an effective use of the instru-ment.between and across approaches, our goal remains the same: to enable a person to grow and facilitate the perception of wellness in his being in the world. this is the most ambitious result we should strive for. to use Maria Montessori’s words: “proof of the correct-ness of our educational action comes from the child’s happiness”.4antonio trabacca *, luigi russounit for severe disabilities in developmental age and young adults (developmental Neurology and Neurorehabilitation), Scientific Institute IRCCS “Eugenio Medea”– “La Nostra famiglia”, brindisi research centre, brindisi, italy*corresponding author: antonio trabacca, unit for severe disabilities in developmental age and young adults (developmental Neurology and Neu-rorehabilitation), Scientific Institute IRCCS “Eugenio Medea”– “La Nostra famiglia”, brindisi research centre, Ex complesso ospedaliero “a. di summa”, piazza “a. di summa”, 72100 brindisi, italy. E-mail: antonio.trabacca@os.lnf.itReferences 1. Moretti G. (a cura di cannao M., Moretti a.). riabilitazione e inte-grazione del disabile - dai principi ai metodi. roma: armando; 2006. 2. schopler E, reicher rJ, lansing M. strategie educative nell’autismo. Milan: Masson; 1991. 3. ferrari a. proposte riabilitative nelle paralisi cerebrali infantili. pisa: Edizioni del cerro; 1997. 4. Montessori M. formazione dell’uomo. Milan: Garzanti;1968.Conflicts of interest.—The authors certify that there is no conflict of inter-est with any financial organization regarding the material discussed in the manuscript.Article first published online: May 11, 2016. - Manuscript accepted: May 5, 2016. - Manuscript revised: March 8, 2016. - Manuscript received: septem-ber 8, 2015.(Cite this article as: trabacca a, russo l. pediatric rehabilitation: a chang-ing panorama in the high-tech era? Eur J phys rehabil Med 2016; 52:593-4)© 2015 EdiZioNi MiNErVa MEdicaonline version at http://www.minervamedica.it  ; ( ):technology-aided behavioral programs for helping persons in or emerged from a minimally conscious statedear Editor,persons in a minimally conscious state (Mcs) or emerged from such a state, who are affected by extensive neurological damage, pervasive motor impairment and lack of speech, tend European Journal of physical and rehabilitation Medicine 2016 august;52(4):594-5              COPYRIGHT© 2016 EDIZIONI MINERVA MEDICA This document is protected by international copyright laws.No additional reproduction is authorized.It is permitted for personal use to download and save only one file and print only one copy of this Article.It is not permitted to make additional copies(either sporadically or systematically, either printed or electronic) of the Article for any purpose.It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any othermeans which may allow access to the Article.The use of all or any part of the Article for any Commercial Use is not permitted.The creation of derivative works from the Article is not permitted.The production of reprints for personal or commercial use isnot permitted.It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article.It is not permitted to frame or use framing techniques to enclose any trademark, logo,or other proprietary information of the Publisher.  lEttErs to thE EditorVol. 52 - No. 4 EuropEaN JourNal of physical aNd rEhabilitatioN MEdiciNE 595Giulio E. laNcioNi 1 *, Nirbhay N. siNGh 2, Mark f. o’rEilly 3, Jeff siGafoos 4, Marta oliVEtti bElardiNElli 51university of bari, bari, italy; 2Medical college of Georgia, Georgia regents university, augusta, Ga, usa; 3university of texas at austin, tX, usa; 4Victoria university of Wellington, Wellington, New Zealand; 5sapienza university of rome, rome, italy*corresponding author: Giulio E. lancioni, department of Neuroscience and sense organs, university of bari, corso italia 23, 70121 bari, italy. E-mail: giulio.lancioni@uniba.itReferences 1. lancioni GE, bosco a, olivetti belardinelli M, singh NN, o’reilly Mf, sigafoos J, oliva d. technology-based intervention programs to promote stimulation control and communication in post-coma persons with different levels of disability. front hum Neurosci 2014;8:48. 2. lancioni GE, singh NN, o’reilly Mf, sigafoos J, olivetti belar-dinelli M, buonocunto f, et al. supporting self-managed leisure en-gagement and communication in post-coma persons with multiple disabilities. res dev disabil 2015;38:75-83. 3. lancioni GE, singh NN, o’reilly Mf, Green Va, buonocunto f, sacco V, et al. Microswitch-aided programs with contingent stimula-tion versus general stimulation programs for post-coma persons with multiple disabilities. dev Neurorehabil 2014;17:251-8. 4. lancioni GE, singh NN, o’reilly Mf, sigafoos J, olivetti belar-dinelli M, et al. technology-aided programs for post-coma patients emerged from or in a minimally conscious state. front hum Neurosci 2014;8:931.Conflicts of interest.—The authors certify that there is no conflict of inter-est with any financial organization regarding the material discussed in the manuscript.Article first published online: December 2, 2015. - Manuscript accepted: No-vember 30, 2015. - Manuscript received: september 24, 2015.(Cite this article as: lancioni GE, singh NN, o’reilly Mf, sigafoos J, olivetti belardinelli M. technology-aided behavioral programs for help-ing persons in or emerged from a minimally conscious state. Eur J phys rehabil Med 2016;52:594-5)love you”). once the participant selects a message (again by mi-croswitch activation), the computer sends that message out. the participant can have any incoming message read out through microswitch activation.sixth level: the program allows the participant to choose among and within communication and occupation options.2 for example, the computer may present options such as music, videos, text messages, and statements/requests. if the participant chooses (by microswitch activation) music or videos, the computer presents a variety of song titles or videos’ titles. When the participant chooses one of them, the computer plays it for 2-3 min. if the participant chooses text messages, the conditions are as described above. if the participant chooses statements/requests, the computer pres-ents boxes with phrases asking for body movements, stating basic needs, and requesting for information, respectively. choosing a phrase leads the computer to verbalize it aloud so the caregiver can hear and respond.sixth level revised: if a participant is affected by global aphasia, the aforementioned program needs to be revised. it might, for ex-ample, be limited to options such as music, videos, and statements/requests and rely totally on visual images.2 initially, the comput-er may present visual images of those options. if the participant chooses music, the computer may present the photos of various singers. choosing a singer would lead the computer to play one of his or her songs. if the participant chooses videos, the computer may present a number of 5-s video clips in succession. choosing a video clip would lead the computer to present the correspond-ing video. if the participant chooses statements/requests, boxes with images replacing the aforementioned phrases would appear. choosing one of the images would lead the computer to verbal-ize the corresponding sentence to allow the caregiver to hear and respond.in conclusion, the six program levels described above (includ-ing the revised version of the sixth program level) and the prelimi-nary data obtained by the early studies assessing them seem to of-fer a new perspective for persons with serious multiple disabilities. it might also be noteworthy that the technology required for those programs is relatively simple and inexpensive.              COPYRIGHT© 2016 EDIZIONI MINERVA MEDICA This document is protected by international copyright laws.No additional reproduction is authorized.It is permitted for personal use to download and save only one file and print only one copy of this Article.It is not permitted to make additional copies(either sporadically or systematically, either printed or electronic) of the Article for any purpose.It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any othermeans which may allow access to the Article.The use of all or any part of the Article for any Commercial Use is not permitted.The creation of derivative works from the Article is not permitted.The production of reprints for personal or commercial use isnot permitted.It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article.It is not permitted to frame or use framing techniques to enclose any trademark, logo,or other proprietary information of the Publisher.

Technology-aided behavioral programs for helping persons in or emerged from a minimally conscious state

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Technology-aided behavioral programs for helping persons in or emerged from a minimally conscious state

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