IMR Press / JIN / Volume 21 / Issue 6 / DOI: 10.31083/j.jin2106158
Open Access Review
A Behavioral Approach to Treatment and Assessment of People with Disorders of Consciousness: The Response-contingent Stimulation Strategy
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1 Department of Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy
2 Department of Psychology, Sapienza University, 00185 Rome, Italy
3 Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA 30912, USA
4 College of Education, University of Texas at Austin, TX 78712, USA
5 School of Education, Victoria University of Wellington, 6012 Wellington, New Zealand
6 Lega F. D’Oro Research Center, 60027 Osimo, Italy
7 Department of Psychology, University of Bologna, 40126 Bologna, Italy
*Correspondence: (Giulio E. Lancioni)
Academic Editors: Sergio Bagnato and Gernot Riedel
J. Integr. Neurosci. 2022, 21(6), 158;
Submitted: 16 June 2022 | Revised: 20 July 2022 | Accepted: 21 July 2022 | Published: 21 September 2022
(This article belongs to the Special Issue Disorders of Consciousness: From Pathophysiology to Treatment)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Response-contingent stimulation is a behavioral strategy used to improve the situation of patients with disorders of consciousness. Such strategy involves the presentation of brief periods (e.g., 10 to 15 s) of stimulation considered preferred by the patients, contingent on (immediately after) the emission of specific patients’ responses. The aim is to help the patients learn the link between their responding and the preferred stimulation and thus learn to use their responding to access the stimulation in a self-determined/independent manner. Achieving these goals is considered important for the patients’ recovery process and thus the response-contingent stimulation strategy that promotes such an achievement can be considered a valuable treatment approach. The same strategy combined with the use of periods of non-contingent stimulation (i.e., stimulation delivered independent of responding) may also serve as an assessment supplement with patients with apparent unresponsive wakefulness. The patients’ increase in responding during the response-contingent stimulation and decline in responding during the non-contingent stimulation could be taken as a sign of discrimination between conditions, and possibly a sign of awareness of the immediate environmental situation, compatible with a diagnosis of minimally conscious state. This paper analyzes a number of studies aimed at using the response-contingent stimulation as a treatment strategy and a number of studies aimed at combining response-contingent stimulation with non-contingent stimulation for treatment and assessment purposes. The results of the studies are discussed in terms of the effectiveness, accessibility and affordability of the strategy. The need for new research (i.e., replication studies) is also pointed out.

disorders of consciousness
response-contingent stimulation
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