[Show abstract][Hide abstract] ABSTRACT: These two studies assessed technology-aided programs for fostering sustained occupational engagement and mobility in persons with multiple disabilities who typically failed to move through sequences of activities. Study I involved two participants with severe intellectual disability and blindness. The program ensured automatic presentation of (a) auditory cues to guide the participants to different workstations with activities, and (b) musical and social (reinforcing) stimulation at the participants’ arrival at each of the workstations. Study II involved one participant with severe to profound intellectual disability and moderate hearing impairment. The program presented combinations of auditory and visual cues to guide the participant to the workstations and positive social consequences as she reached them. The results of both studies were largely positive. The participants’ mean percentages of independent transition moves (i.e., moves to reach the different workstations available and carry out the activities scheduled) increased from zero or below 20 at the beginning of the study (under baseline conditions) to about 95 by the end of the study (with the use of the programs). Practical and technical implications of the results for daily intervention with persons with multiple disabilities are discussed.
Journal of Developmental and Physical Disabilities 12/2014; 26(6). DOI:10.1007/s10882-014-9390-4 · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background This study aimed to assess a microswitch-aided program for helping 2 persons with multiple disabilities, who presented with head and shoulder posture problems, to exercise a combination of appropriate head and arm movements. Method The program involved microswitches for monitoring participants' head and arm movements. A computer system recorded those movements and provided brief stimulation contingent on them during intervention. Three intervention phases took place, which focused on head movements, arm movements, and the combination of the 2 movements, respectively. Four weeks after the last intervention phase, a post-intervention check occurred. Results Both participants increased the frequencies of (a) the head and the arm movements during the first 2 intervention phases, respectively, and (b) those movements combined during the third intervention phase. Positive performance was maintained at the post-intervention check. Conclusions Microswitch-aided programs can support exercise of complex response schemes of persons with multiple disabilities.
[Show abstract][Hide abstract] ABSTRACT: Three microswitch-aided programs were assessed in three single-case studies to enhance physical exercise or ambulation in participants with multiple disabilities. Study I was aimed at helping a woman who tended to have the head bending forward and the arms down to exercise a combination of appropriate head and arms movements. Study II was aimed at promoting ambulation continuity with a man who tended to have ambulation breaks. Study III was aimed at promoting ambulation with appropriate foot position in a girl who usually showed toe walking. The experimental designs of the studies consisted of a multiple probe across responses (Study I), an ABAB sequence (Study II), and an ABABB(1) sequence (Study III). The last phase of each study was followed by a post-intervention check. The microswitches monitored the target responses selected for the participants and triggered a computer system to provide preferred stimuli contingent on those responses during the intervention phases of the studies. Data showed that the programs were effective with each of the participants who learned to exercise head and arms movements, increased ambulation continuity, and acquired high levels of appropriate foot position during ambulation, respectively. The positive performance levels were retained during the post-intervention checks. The discussion focused on (a) the potential of technology-aided programs for persons with multiple disabilities and (b) the need of replication studies to extend the evidence available in the area.
Research in Developmental Disabilities 06/2014; 35(9):2190-2198. DOI:10.1016/j.ridd.2014.05.015 · 3.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper provides an overview of microswitch-based programs for persons with multiple disabilities. Three types of programs are included in the overview: Firstly, programs involving only one microswitch, aimed at promoting specific response engagement in relation to contingent environmental stimulation; secondly, programs involving one or two microswitches, directed at promoting response engagement and choice; thirdly, programs typically involving a combination of two microswitches, aimed at promoting response engagement as well as reducing problem posture or problem behavior. This paper also provides general considerations about the programs reviewed (i.e., in terms of applicability, potential benefits, and costs), and suggests several issues for new research in the area.
[Show abstract][Hide abstract] ABSTRACT: These two studies were aimed at assessing technology-aided programs to help persons with multiple disabilities engage in basic occupation or work activities. Specifically, Study I focused on teaching two participants (an adolescent and an adult) with low vision or total blindness, severe/profound intellectual disabilities, and minimal object interaction to engage in constructive object-manipulation responses. The technology monitored their responses and followed them with brief stimulation periods automatically. Study II focused on teaching three adults with deafness, severe visual impairment, and profound intellectual disabilities to perform a complex activity, that is, to assemble a five-component water pipe. The technology regulated (a) light cues to guide the participants through the workstations containing single pipe components and the carton for completed pipes and (b) stimulation events. The results of both studies were positive. The participants of Study I showed consistent and independent engagement in object-manipulation responses. The participants of Study II showed consistent and independent pipe assembling performance. General implications of the two programs and the related technology packages for intervention with persons with multiple disabilities are discussed.
Research in developmental disabilities 06/2014; 35(6):1264–1271. DOI:10.1016/j.ridd.2014.03.026 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Interventions for post-coma persons, who have emerged from a minimally conscious state but present with extensive neuro-motor impairment and lack of or minimal verbal skills, need to promote occupation and communication through the use of assistive technology.
These two studies were aimed at assessing two technology-aided programs to promote leisure engagement and communication for three post-coma participants with multiple disabilities.
Study I assessed a program to allow a woman and a man with extensive neuro-motor impairment and lack of speech to switch on music and videos, make requests to caregivers, and send messages to (communicate with) relevant partners and receive messages from those partners. Study II assessed a program to allow a post-coma woman with extensive motor impairment and reduced verbal behavior to activate music, videos and requests, send and receive messages, and make telephone calls.
Data showed that both programs were successful. The participants of Study I managed leisure engagement, requests, as well as text messaging. The participant of Study II showed consistent leisure engagement, text messaging, and telephone calls.
Assistive technology can be profitably used to provide post-coma persons with multiple disabilities relevant leisure and communication opportunities.
[Show abstract][Hide abstract] ABSTRACT: Background This study extended the assessment of a technology-aided orientation program with auditory cues by including 2 participants with multiple disabilities who had difficulties in indoor travel and showed travel-related anxiety behaviours (e.g., calling for help and whimpering). Method The study was carried out according to a multiple probe design across 2 settings for the first participant and an ABAB design for the second participant. Data collection served to determine whether the orientation technology used during the intervention phases of the study and the postintervention check had a positive impact on the participants' indoor travel and anxiety behaviours. Results Data showed that both participants learned to travel successfully with the support of the technology. Concomitant with their successful travel, anxiety-related behaviours were eliminated or reduced to minimal levels. Conclusions Technology-aided orientation programs may be effective for both promoting correct indoor travel and reducing travel-related anxiety behaviours.
[Show abstract][Hide abstract] ABSTRACT: Recent studies with three persons with multiple disabilities have indicated that smile expressions can be used as functional choice responses (i.e., occurring in relation to samples of preferred stimuli to be selected and absent in relation to samples of non-preferred stimuli to be bypassed). The purpose of this study was to extend the evaluation of the smile response with two new participants (a girl and a woman) with multiple disabilities within a technology-aided choice program. The smile response was monitored through an optic microswitch pointing to the girl’s lower lip or across the area before the woman’s right cheekbone. The study started with a baseline phase during which the participants were to use a vocalization response to choose among the stimuli presented to them. The intervention phase with the smile response and optic microswitch was introduced according to a non-concurrent multiple baseline design across participants. The results showed that both participants used the smile response and optic microswitch to choose the preferred stimuli and abstained from using such response (i.e., from making choices) in relation to non-preferred stimuli. Implications of the results are discussed.
Journal of Developmental and Physical Disabilities 04/2014; 26(2). DOI:10.1007/s10882-013-9353-1 · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Post-coma persons in a minimally conscious state and with extensive motor impairment or emerging/emerged from such a state, but affected by lack of speech and motor impairment, tend to be passive and isolated. A way to help them develop functional responding to control environmental events and communication involves the use of intervention programs relying on assistive technology. This paper provides an overview of technology-based intervention programs for enabling the participants to (a) access brief periods of stimulation through one or two microswitches, (b) pursue stimulation and social contact through the combination of a microswitch and a sensor connected to a speech generating device (SGD) or through two SGD-related sensors, (c) control stimulation options through computer or radio systems and a microswitch, (d) communicate through modified messaging or telephone systems operated via microswitch, and (e) control combinations of leisure and communication options through computer systems operated via microswitch. Twenty-six studies, involving a total of 52 participants, were included in this paper. The intervention programs were carried out using single-subject methodology, and their outcomes were generally considered positive from the standpoint of the participants and their context. Practical implications of the programs are discussed.
Frontiers in Human Neuroscience 02/2014; 8(1):48. DOI:10.3389/fnhum.2014.00048 · 3.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: These two studies were aimed at extending the assessment of technology-aided programs to enhance leisure occupation or communication with persons with extensive neuro-motor impairment and lack of speech. Specifically, Study I implemented the program for leisure occupation with two post-stroke patients. Study II implemented the program for communication with two persons affected by amyotrophic lateral sclerosis (ALS). In Study I, a computer system presented the participants with a variety of stimuli. The participants could select/access those stimuli by microswitch activation or could bypass them by abstaining from microswitch responses. In Study II, the participants used a computer-aided telephone system that allowed them to choose via microswitch activation the persons to call. On the computer screen, they also had words and phrases that they could activate during the calls to influence the conversation with the persons called. Data from both studies were largely positive. The post-stroke patients showed high levels of stimulus selection (access) and extended engagement. The patients with ALS were able to make phone calls and to select the words/phrases to influence the conversations. The relevance of technology-aided programs for leisure occupation and communication of persons with extensive multiple disabilities was discussed.
Research in developmental disabilities 01/2014; 35(3). DOI:10.1016/j.ridd.2014.01.002 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This chapter provides an overview of studies that focused on intervention programs and technological resources directed at enhancing the performance/achievement of persons with severe and profound intellectual and multiple disabilities. The general goals of the studies included in the review were promoting adaptive behavior and environmental stimulation control (and occasionally also reducing problem posture/behavior), communication, preliminary ambulation skills, indoor orientation and travel, and task engagement. The studies are divided in four groups (with possible subgroups) based on the technological resources they assessed. The main technological resources employed were: microswitches, speech-generating devices (SGDs), spatial orientation systems, and activity instruction systems. The final part of the chapter provides general considerations about the studies (technological resources) reviewed and their implications for daily programs and also suggests several issues for new research in the area.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
These two studies extended technology-aided programs to promote leisure and communication opportunities to a man with cervical spinal cord injury and a post-coma man with multiple disabilities.
The studies involved the use of ABAB designs, in which A and B represented baseline and intervention phases, respectively. The programs focused on enabling the participants to activate songs, videos, requests, text messages, and telephone calls. These options were presented on a computer screen and activated through a small pressure microswitch by the man with spinal cord injury and a special touch screen by the post-coma man. To help the latter participant, who had no verbal skills, with requests and telephone calls, series of words and phrases were made available that he could activate in those situations.
Data showed that both participants were successful in managing the programs arranged for them. The man with spinal cord injury activated mean frequencies of above five options per 10-min session. The post-coma man activated mean frequencies of about 12 options per 20-min session.
Technology-aided programs for promoting leisure and communication opportunities might be successfully tailored to persons with spinal cord injury and persons with post-coma multiple disabilities. Implications for Rehabilitation Technology-aided programs may be critical to enable persons with pervasive motor impairment to engage in leisure activities and communication events independently. Persons with spinal cord injury, post-coma extended brain damage, and forms of neurodegenerative disease, such as amyotrophic lateral sclerosis, may benefit from those programs. The programs could be adapted to the participants' characteristics, both in terms of technology and contents, so as to improve their overall impact on the participants' functioning and general mood.
Disability and rehabilitation. Assistive technology 11/2013; 10(1). DOI:10.3109/17483107.2013.860635
[Show abstract][Hide abstract] ABSTRACT: Objective:
Assessing automatic feedback technologies to promote safe travel and speech loudness control in two men with multiple disabilities, respectively.
The men were involved in two single-case studies. In Study I, the technology involved a microprocessor, two photocells, and a verbal feedback device. The man received verbal alerting/feedback when the photocells spotted an obstacle in front of him. In Study II, the technology involved a sound-detecting unit connected to a throat and an airborne microphone, and to a vibration device. Vibration occurred when the man's speech loudness exceeded a preset level.
The man included in Study I succeeded in using the automatic feedback in substitution of caregivers' alerting/feedback for safe travel. The man of Study II used the automatic feedback to successfully reduce his speech loudness.
Automatic feedback can be highly effective in helping persons with multiple disabilities improve their travel and speech performance.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To assess whether a man with amyotrophic lateral sclerosis could benefit from using (a) a mouth pressure microswitch instead of an optic microswitch activated via head movement and (b) a special word prediction function within a text messaging system.
Initially, both microswitches were used for operating the text messaging system, and their effectiveness and the man's preference were assessed. Subsequently, only the mouth microswitch was used and the messaging system was provided with a word prediction function.
The man was more efficient/rapid in using the text messaging (i.e., in writing) with the mouth microswitch and preferred such a microswitch. Similarly, he was more rapid in writing when the word prediction function was added (as opposed to the initial phase of the study when such function was not available) and preferred to use it.
Technology updates are critical in helping persons with motor degeneration.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To assess whether two persons with multiple disabilities could learn a work activity (i.e., assembling trolley wheels) with the support of a technology system.
After an initial baseline, the study compared the effects of intervention sessions relying on the technology system (which called the participants to the different workstations and provided feedback and final stimulation) with the effects of intervention sessions carried out without technology. The two types of intervention sessions were conducted according to an alternating treatments design. Eventually, only intervention sessions relying on the technology system were used.
Both participants managed to assemble wheels independently during intervention sessions relying on the technology system while they failed during sessions without the system. Their performance was strengthened during the final part of the study, in which only sessions with the system occurred.
Technology may be critical in helping persons with multiple disabilities manage multi-step work activities.
[Show abstract][Hide abstract] ABSTRACT: Persons with multiple disabilities, including pervasive motor impairment, may have problems controlling even small responses (e.g., vocal emissions, finger movements, or prolonged eyelid closures) within time-sensitive situations, such as those involved in choice programs. Recent research has indicated that smile expressions can be used as functional choice responses for some of these persons. The present two studies were aimed at assessing the smile response for a child with congenital multiple disabilities and a tongue response for a post-coma man who had recovered his consciousness but presented with pervasive multiple disabilities. The first of the two studies represented a research extension (i.e., a new case with a slightly adapted microswitch technology) concerning the smile response, which had recently been evaluated with few other cases. The second study represented a new effort to assess the tongue response within a choice program and for a post-coma man with multiple disabilities. The results showed that the participants used the smile and the tongue responses successfully while they were apparently unsuccessful in using a slight head/chin movement response. Their choice behavior focused reliably on preferred stimuli and avoided non-preferred stimuli. Implications of the results are discussed.
Research in developmental disabilities 09/2013; 34(11):4232-4238. DOI:10.1016/j.ridd.2013.09.003 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study assessed whether a girl and a woman with multiple disabilities could (a) make phone contacts with relevant partners through a special telephone technology, and (b) enjoy their telephone-mediated communication with them. The technology involved a net-book computer, a global system for mobile communication modem (GSM), an optic microswitch, and specific software. The technology was programmed to present the names of the partners available for contact, and the participants could choose at each presentation sequence the one they wanted to contact with a simple microswitch response. Such response triggered the computer to place a phone call to that partner. Both participants (a) learned to use the technology quite rapidly to contact relevant partners and maintained the successful use of it over the intervention and post-intervention sessions, (b) showed high levels of indices of happiness during the phone calls as opposed to pre-baseline control sessions, and (c) showed preferences among the partners. Implications of the findings are discussed.
Research in developmental disabilities 09/2013; 34(11):4178-4183. DOI:10.1016/j.ridd.2013.08.042 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: I bambini affetti da disabilità intellettive e motorie gravi e profonde hanno spesso difficoltà di equilibrio e deambulazione e trascorrono gran parte del loro tempo seduti o sdraiati, con conseguenze negative per il loro sviluppo. La ricerca ha recentemente dimostrato la possibilità di utilizzare ausili per la deambulazione (con supporto) e microswitch con stimoli preferiti per promuovere la deambulazione in questi bambini. Questo studio è servito da replica per le ricerche precedentemente svolte e ha coinvolto cinque bambini con disabilità multipla.
Per quattro bambini, è stato adottato un disegno sperimentale di tipo abab, mentre per il quinto bambino è stata usata soltanto la sequenza ab. Tutti i bambini sono riusciti ad aumentare le loro frequenze di risposte di deambulazione durante le fasi b d’intervento dello studio, sebbene le frequenze generali di tali risposte variassero enormemente da un bambino all’altro. Questi risultati sostengono i dati positivi già disponibili sull’efficacia di questo approccio d’intervento nel motivare e promuovere la deambulazione dei bambini. Vengono infine discusse le implicazioni pratiche di questi risultati.
[Show abstract][Hide abstract] ABSTRACT: Study I used typical microswitch-cluster programs to promote adaptive responding (i.e., object manipulation) and reduce inappropriate head or head-trunk forward leaning with a boy and a woman with multiple disabilities. Optic, tilt, and vibration microswitches were used to record their adaptive responses while optic and tilt microswitches monitored their posture. The study included an ABB(1)AB(1) sequence, in which A represented baseline phases, B represented an intervention phase in which adaptive responses were always followed by preferred stimulation, and B(1) represented intervention phases in which the adaptive responses led to preferred stimulation only if the inappropriate posture was absent. Study II assessed a non-typical, new microswitch-cluster program to promote two adaptive responses (i.e., mouth cleaning to reduce drooling effects and object assembling) with a man with multiple disabilities. Initially, the man received preferred stimulation for each cleaning response. Then, he received stimulation only if mouth cleaning was preceded by object assembling. The results of Study I showed that both participants had large increases in adaptive responding and a drastic reduction in inappropriate posture during the B(1) phases and a 2-week post-intervention check. The results of Study II showed that the man learned to control drooling effects through mouth cleaning and used object assembling to extend constructive engagement and interspace cleaning responses functionally. The practical implications of the findings are discussed.
Research in developmental disabilities 08/2013; 34(10):3411-3420. DOI:10.1016/j.ridd.2013.07.014 · 4.41 Impact Factor