Andrea Bosco

An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state.

This paper presents an overview of the studies directed at helping post-coma persons with minimally conscious state improve their adaptive behavior. Twenty-one studies were identified for the 2000-2010 period (i.e., a period in which an intense debate has occurred about diagnostic, rehabilitative, prognostic, and ethical issues concerning people with severe acquired brain injury). Three of the 21 studies involved transcortical magnetic or deep brain stimulation. Six studies focused on the provision of multisensory stimulation or music therapy. The remaining 12 studies involved the use of response-related (contingent) stimulation and assistive technology. The outcomes of the studies, which were generally reported as positive, were discussed in terms of (a) the size (quantitative relevance) of the changes obtained, (b) the credibility/reliability of the changes, in light of the methodological conditions of the studies, and (c) the level of engagement and interaction involvement of the participants. Relevant issues for future research were also examined.

Relationship between Hardiness and Risk of Burnout in a Sample of 92 Nurses Working in Oncology and AIDS Wards

BACKGROUND The present study tested the hypothesis that particular personality dispositions act as resistance resources in the encounter with stressful life events. METHODS The sample consisted of 100 student nurses working in critical areas (oncology and AIDS). At the beginning of the 2nd year course subjects were administered the Kobasa Hardiness Scale and at the end of the year the Maslach Burnout Inventory. RESULTS Higher hardiness levels at the beginning of the course were associated with lower emotional exhaustion and higher personal achievement scores at the end. As predicted, findings show hardiness scores to be predictive of the risk of burnout. CONCLUSIONS A screening of personality traits could be useful in preventing the risk of burnout in nurses working in critical areas.

Technology-based intervention options for post-coma persons with minimally conscious state and pervasive motor disabilities

Background: Intervention strategies, based on learning principles and assistive technology, were assessed with four post-coma persons with minimally conscious state and pervasive motor disabilities. Method: The first study taught a man to access environmental stimulation through a response-microswitch combination and another man to access environmental stimulation and request social contact through responses combined with a microswitch or a Voice Output Communication Aid (VOCA). The second study taught a man to access two forms of environmental stimulation via two response-microswitch combinations and another man to request two forms of contact via two response-VOCA combinations. Results: Data showed that all participants had significant increases in response levels (independent of whether the responses were combined with microswitch or VOCA devices) during the intervention phases of the studies. Conclusion: Intervention strategies based on learning principles and technology may be largely helpful for persons with minimally conscious state and pervasive motor disabilities.

Vegetative state: efforts to curb misdiagnosis

Media reports on the case of Rom Houben have constituted a new reminder of the risks of misdiagnosis with cases with apparent vegetative state, particularly when following the clinical consensus of the care team as diagnostic criterion. Systematic use of behavioral and non-behavioral assessment strategies (e.g., behavioral scales, event-related potentials, and neuro-imaging) may help reduce the aforementioned risks. A new learning assessment strategy could also be considered part of the assessment to extend the evaluation process. Signs of learning might be viewed as forms of concrete knowledge representing a basic level of non-reflective consciousness.

Assistive technology for promoting choice behaviors in three children with cerebral palsy and severe communication impairments

A technology-based program to promote independent choice behaviors by three children with cerebral palsy and multiple disabilities was assessed. The program was based on learning principles and assistive technology (i.e., customized input devices/sensors, personal computers, screening of preferred stimuli according to a binomial criterion). The first purpose of the present study was to provide the participants with a new set-up of assistive technology and to allow them to choose among three categories (i.e., food, beverage and leisure), and to request a specific item out of four in each category, adopting a procedure that minimized (according to a conditional probability criterion) unintentional choices. The second aim of the study was to carry out the effects of the program on detectable mood signs (i.e., happiness index). The study was conducted according to an ABAB sequence with a subsequent post intervention check for each participant. The results showed an increase of engagement and of the happiness index during intervention phases. Psychological as well as educational implications were discussed.

Assessing human reorientation ability inside virtual reality environments: the effects of retention interval and landmark characteristics

The purpose of the present study was to assess the navigational behaviour of adult humans following a disorientation procedure that perturbed their egocentric frame of reference. The assessment was carried out in a virtual reality (VR) environment by manipulating the disorientation procedure, the retention interval, the relative positions of target and landmark. The results of experiment I demonstrated that adding a physical rotation to a virtual disorientation procedure did not yield an additional decrease in searching performance. The results of experiment II showed that shortening the delay between study and test phase decreased the errors more markedly for geometric than landmark ones. An orientation specificity effect due to the manipulation of the relative position between target and landmark was discussed across the experiments. In conclusion, VR seemed to be a valuable method for studying human reorientation. Moreover, the virtual experimental setting involved here promoted knowledge of the relationship between working memory and spatial reorientation paradigm.

Reorientation Deficits Are Associated With Amnestic Mild Cognitive Impairment

Background/Aims: Spatial memory can be impaired in amnestic mild cognitive impairment (aMCI). The present study investigates categorical spatial memory deficits using a virtual navigation-based reorientation task. Methods: Twenty-eight amnestic single domain and 23 amnestic multiple domain patients were compared with 53 healthy elderly controls on the performance of the virtual reorientation test (VReoT). Results: The reorientation performance of participants in both aMCI groups was significantly worse than that of controls suggesting that VReoT detects spatial memory deficits. No significant difference emerged between the 2 groups of patients. A subsequent receiver–operating characteristic analysis showed that a score of 8 had a sensitivity of 80.4% and a specificity of 94.3% (area under the curve = 0.90). Conclusion: The VReoT seemed to be accurate in differentiating patients with aMCI from controls and may represent an evaluation supplement for spatial memory deficits in prodromal stages of Alzheimer’s dementia.

Comparing two different orientation strategies for promoting indoor traveling in people with Alzheimer's disease

The present study compared two different types of orientation strategies: an assistive technology program (AT, i.e., remotely controlled sound/light devices) and a backward chaining procedure (BC) for promoting indoor traveling in four persons with moderate to severe Alzheimers disease (AD). A social validation assessment of the two strategies was also conducted employing undergraduate students as raters. For three out of four participants, AT intervention was more effective than the BC procedure, whilst for the fourth participant the two types of intervention had a comparably satisfying efficacy. A doubly Multivariate Analysis of Variance on social validation assessment data provided generally more positive scores for the AT intervention. These results suggest that AT programs (a) can be valuably employed for restoring and maintaining independence in indoor traveling in people with moderate to severe AD, and (b) might be perceived as preferable to conventional teaching strategies within daily contexts.

Preventing Burnout in Mental Health Workers at Interpersonal Level: An Italian Pilot Study

This pilot study longitudinally evaluated the effectiveness of an intervention aimed at preventing burnout syndrome through the improvement of interpersonal relationship management among Italian mental health workers employed in both public and private services. Indeed, previous findings and a large part of the target group stated that the interpersonal relationship was one of the most important sources of stress at work. The results showed positive effects (i.e. a reduction of the level of Depersonalization), both at the end of training activities and at the follow-up. Since we did not include any control group, the results of this study had to be considered with caution and should be confirmed by future research.

Technology-based orientation programs to support indoor travel by persons with moderate Alzheimer's disease: impact assessment and social validation.

The present study (a) extended the assessment of an orientation program involving auditory cues (i.e., verbal messages automatically presented from the destinations) with five patients with Alzheimers disease, (b) compared the effects of this program with those of a program with light cues (i.e., a program in which strobe lights were used instead of the verbal messages) with the same five patients, and (c) conducted a social validation assessment of the two programs with 70 university psychology students employed as social raters. Results confirmed the effectiveness of the program with auditory cues and showed an equally strong impact of the program with light cues with all five patients. The psychology students involved in the social validation assessment provided significantly higher scores for the program involving light cues on a six-item questionnaire. Those scores suggested that this program was perceived as a practically and socially preferable choice. The implications of the findings for daily contexts dealing with patients with Alzheimers disease are discussed.