The therapeutic intervention for persons with profound multiple disabilities - Case study using near-infrared spectroscopy

[Background and aims] Many of persons with profound multiple disabilities (PMD) have difficulty in responding verbally to their families and therapists. Families and therapists recognize their responses through their facial expression, eyes and muscle tones. Moreover, they try to interpret the meaning of their physical responses. The purpose of this research is to clarify the meaning of individual responses expressed by PMDs from an aspect of brain function, and to examine the methodology of therapeutic intervention for them. The researchers also examined the individual task based on the information of their developmental and medical histories as well. The experiments using Near-infrared spectroscopy (NIRS) were conducted in accordance with their individual tasks. In this research, two cases are studied. [Methods] NIRS has been used to enable the researchers to monitor non-invasively variations of concentrations of oxygenated hemoglobin (Oxy-Hb) and deoxygenated Hb (Deoxy-Hb). First case is a 31-year-old male who has cerebral palsy and mental retardation. He can rotate his neck, and flex and abduct his left shoulder joint. His father is a truck driver, and he used to play cassette tapes constantly whenever he drove with his son on the passenger's seat. The tapes were of Enka (Japanese traditional popular songs). In addition, he can make a vivid response to some particular call. Tasks to be measured are (1) Enka songs which are very familiar to him, (2) the particular call to which he had responded vividly, and (3) other calls to which he has not cared. Data on NIRS were recorded using optical topography system (ETG-4000, Hitachi Medical) with 22 channels placed on the frontal lobe. Second case is a 5-year-old girl with hypoxic brain damage sequela, mental retardation, and epilepsy. She has visual acuity of 0.03 (naked-eye) and 0.4 (with glasses), and auditory acuity of Rt60db and Lt70db. Cervical rotation is possible for her. Her therapists can not observe the change in her everyday life with or without glasses on. The task to be measured is her responses to the therapists' varied voices with eye contact with or without her glasses. Data on NIRS were recorded using optical topography system with 24 channels placed on both lobes-frontal and occipital. [Results] In case 1, an increase of Oxy-Hb was measured in the same specific channel for Enka and voice clearly given. However, and increase of Oxy-Hb was not noticed for voice indefinitely given. In case 2, with glasses on, an increase of Oxy-Hb was measured with most of the channels compared with naked eyes. [Conclusion] 1. The data of NIRS can indicate the task for a necessary therapeutic intervention of PMDs. 2. The task to be measured for NIRS was specified through close observation by family members and therapists, developmental history, medical information and other significant factors. 3. The result of this measurement should be adopted to the therapeutic intervention in daily life. By embracing those results, family members and therapists can easily recognize the subjects' (the man and the child) behavioral changes to bring forth better understanding.