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Top1. Background
Post-coma persons may have different occupational, social and rehabilitation perspectives based on their general motor conditions and communication abilities. Those who have extensive motor impairment and lack conventional (verbal) communication skills (vegetative state) may remain confined within a restricted context with (a) large dependence on caregivers to access environmental events/stimuli and (b) scarce opportunities to progress to forms of relevant occupation and interaction. Those who do not have significant/extensive motor impairment and possess adequate communication (i.e. people in a minimally conscious state or who are emerging/emerged from it) may progress to recover relevant occupational and social functions, with positive implications for their general rehabilitation process and their context. For this latter group, any real chance of gaining independent and constructive engagement and communication would be based on the use of assistive technology.
We present a short overview of different options aimed at improving adaptive behaviors by individuals with acquired brain injuries.
Key Terms in this Chapter
Choice: Possibility to operate a choice among environmental stimuli independently.
Motor impairments: Affecting motor control (loss of substance or alteration of a physiological or anatomical structure or body function), which refers to the capacity of the body, or of a body part to move, regardless of the goal and intended function of the movement produced.
Acquired Brain Injury (ABI): Is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder such as fetal alcohol syndrome, perinatal illness or perinatal hypoxia. ABI can result in cognitive, physical, emotional, or behavioural impairments that lead to permanent or temporary changes in functioning. These impairments result from either traumatic brain injury (e.g. physical trauma due to accidents, assaults, neurosurgery, head injury etc.) or nontraumatic injury derived from either an internal or external source (e.g. stroke, brain tumours, infection, poisoning, hypoxia, ischemia, encephalopathy or substance abuse). ABI does not include damage to the brain resulting from neurodegenerative disorders.
Microswitch-Based Programs: Rehabilitation programs that involves the use of technological devices for the acquisition and the maintenance of specific adaptive responses.
Messaging technology: Net-book computer provided with specific software, a global system for mobile communication (GSM) modem, microswitches, and prerecorded verbal lists of persons’ names and messages. Both participants learned to send out and receive (listen to) messages independently.
VOCA: Electronic augmentative and alternative communication (AAC) systems used to supplement or replace speech or writing for individuals with severe speech impairments, enabling them to verbally communicate their needs.
Alternative and Augmentative Communication: Is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. AAC is used by those with a wide range of speech and language impairments, including congenital impairments such as cerebral palsy, intellectual impairment and autism, and acquired conditions such as amyotrophic lateral sclerosis and Parkinson's disease. AAC can be a permanent addition to a person's communication or a temporary aid.
Minimally Conscious State (MCS): Minimally conscious state (MCS) is defined as a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated. It is a disorder of consciousness distinct from persistent vegetative state and locked-in syndrome. Unlike persistent vegetative state, patients with MCS have partial preservation of conscious awareness.
Assistive Technology: Products and services which assist learning.
Multiple Disabilities: Concomitant cognitive/motor/visual impairments, with behavior/emotional disorder.