RESEARCH REPORT Microswitch technology and contingent stimulation to promote adaptive engagement in persons with minimally conscious state: a case evaluation Giulio E. Lancioni • Nirbhay N. Singh • Mark F. O’Reilly • Jeff Sigafoos • Maria Teresa Amenduni • Jorge Navarro • Francesca Buonocunto • Tommaso Scarabino • Marta Olivetti Belardinelli Received: 16 June 2011 / Accepted: 15 November 2011 / Published online: 1 December 2011 Ó Marta Olivetti Belardinelli and Springer-Verlag 2011 Abstract This study assessed whether a post-coma woman functioning at the lower end of the minimally conscious state would (a) develop adaptive responding through the use of microswitch technology and contingent stimulation, (b) consolidate and maintain her responding over time, and (c) show evidence of response-conse- quences awareness (learning and discrimination). The study involved an ABABB 1 CB 1 sequence in which the A represented baseline phases, the B and B 1 intervention phases, and the C a control phase with continuous stimu- lation. Results indicated that the woman developed adap- tive responding and consolidated it over the intervention phases of the study. The woman also showed evidence of being aware of response-consequences links. Potential implications and limitations of these findings are discussed. Keywords Microswitch Á Contingent stimulation Á Minimally conscious state Á Learning Introduction A diagnosis of minimally conscious state and extensive motor impairment is commonly associated with a person displaying some form of adaptive responding (i.e., engage- ment with environmental events), which might improve as a consequence of intervention/rehabilitation programs (Bosco et al. 2009; Canedo et al. 2002; Coleman and Pickard 2011; Giacino and Kalmar 2005; Giacino and Trott 2004; Lancioni et al. 2009a, b; Laureys and Boly 2007). Intervention pro- grams may be more likely to produce positive effects if adequate intervention strategies are carefully applied. The strategies available in this area include transcortical mag- netic and deep brain stimulation, multisensory stimulation and music therapy, and response-related (i.e., contingent) stimulation supported through basic technology (Barreca et al. 2003; Formisano et al. 2001; Lancioni et al. 2010a, b; Magee 2005; Pape et al. 2009; Schiff et al. 2007). Although all those strategies have variously been asso- ciated with satisfactory outcomes, some considerations (clarifications) might be in order. First, several studies (particularly those dealing with multisensory stimulation and music therapy) presented weak methodological con- trol, and consequently, their data should be interpreted with caution (Barreca et al. 2003; Lancioni et al. 2010a). Sec- ond, studies using transcortical or deep brain stimulation and those with multisensory stimulation or music therapy G. E. Lancioni (&) Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy e-mail: g.lancioni@psico.uniba.it N. N. Singh American Health and Wellness Institute, Verona, VA, USA M. F. O’Reilly Meadows Center for Preventing Educational Risk, University of Texas at Austin, Austin, TX, USA J. Sigafoos Victoria University of Wellington, Wellington, New Zealand M. T. Amenduni S. Raffaele Care Center, Andria, Italy J. Navarro Á F. Buonocunto S. Raffaele Rehabilitation Center, Ceglie, Italy T. Scarabino Neuroradiology, L. Bonomo Hospital, Andria, Italy M. O. Belardinelli ‘‘La Sapienza’’ University of Rome, Rome, Italy 123 Cogn Process (2012) 13:133–137 DOI 10.1007/s10339-011-0428-6