Evaluation of the effectiveness of two clinical training procedures to elicit yes/no responses from patients with a severe acquired brain injury: a randomized single-subject design

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Abstract
Primary objective: Thirteen (10 males) participants with severe acquired brain injuries (ABI) were randomly assigned to two treatments, A or B (ABAB, BABA) in a crossover study to determine which treatment approach elicited more consistent and reliable yes/no responses. Research design: Treatment A consisted of an enriched stimulus environment, collaborative multidisciplinary interventions and additional yes/no response training, while Treatment B consisted of the standard hospital environment and interventions. Main outcomes: An ANOVA showed no order effect (AB vs BA; p ¼ 0:60), but a trend (A vs B; p ¼ 0:07) towards statistical significance for increased responsiveness with treatment A. Inter-rater reliability (n ¼ 10) ranged from fair-to-good, intra class correlation (ICC) 0.51; 95% confidence interval (CI) (0.29–0.93). Post-hoc analyses showed statistically significant increased responsiveness for four participants with treatment A (p < 0:001). Conclusion: Evidence is provided that enhanced communication strategies can improve responsiveness in a sub-group of participants with severe acquired brain injuries.

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