I have just studied this in my Validation Therapy training. First the instructors had us lay down, close our eyes and do deep breathing to relax us. Then, we were instructed not to open our eyes and they walked through the room, making noise, dropping books, coming close to us, overhead paging, etc. The point was to re-enact a scenario of a resident in a vegetative state, with their eyes closed and what they might hear or feel. To start, always always always tell the resident what you are doing before you do it. Make eye contact, get down on one knee at wheel chair level if possible. Use touch- very little at first until a trusting relationship has been established. Validation Therapy is based on the losses of the very old which may result in an inward , closing in to the kind of resident that you describe. Think of all the losses, mobility, financial, role of breadwinner, husband, father, social losses- loss of spouse, friends, etc, loss of independence, loss of dignity- think of the horrible reality of three shifts of people you don't know doing unspeakable things to you, waking you up at night, changing you, wiping your butt, making noise, etc. Close in more! Your job would be to move in slow and try to establish a relationship from his perspective. Find out what he did for a living, look in the chart and call a relative for infromation. Touch should be possibly on an arm, and later maybe a small brush of the cheek. This resident may speak later, I have had this happen. Sometimes they just have better days than others. Think about what kind of music might have been popular during his life and learn that song (try music from WWII, there were some great songs from that era and that would have put this man in his 40's) or earlier, from the twenties - I feel you are my sunshine has been utilized ad nauseum, but the residents seem to really enjoy it. If he was religious, a tape of old hymns may be appropriate. Always introduce yourself and tell him what you are doing and why, even to go so far as saying you are a student with an assignment. Don't give up, but keep your sessions to only 10-`15 minutes. Think of all the senses and how you would stimulate them- a light sent of woman's cologne, or a light man's cologne, flowers, bread baking. The touch of cotton, (sounds like the commercial!) or velvet. PM me if you need more ideas or try validation therapy on a search engine for more informatiion.