Two women with multiple disabilities communicate with distant partners via a special text messaging system

This study extended the research on a special text messaging system, which allows persons with multiple disabilities to (a) write and send messages to distant partners and (b) have messages from those partners read out to them. The study involved two women with multiple disabilities (including blindness or minimal residual vision). The system comprised a net-book computer, a mobile communication modem, and an input microswitch, and relied on special keyboards (not used before) to allow the women to write their messages. One of the keyboards included (a) two rows of 10 and 11 keys, respectively, reporting the 21 basic letters of the Italian alphabet arranged in alphabetical order and marked with Braille labels and (b) a space bar and an enlarged back/erase key. The other keyboard had Braille cues on the initial, central, and final keys of the letter rows. Moreover, most function keys were covered (cut out from the usable space). Both women learned to use the messaging system with the special keyboards successfully (i.e., to write their messages, to send them out, and to listen to incoming messages). These findings are analyzed in relation to preliminary data with the system and the need to adapt the writing technology to the participants' characteristics.

Technology-based orientation programs to support indoor travel by persons with moderate Alzheimer's disease: impact assessment and social validation

The present study (a) extended the assessment of an orientation program involving auditory cues (i.e., verbal messages automatically presented from the destinations) with five patients with Alzheimer's disease, (b) compared the effects of this program with those of a program with light cues (i.e., a program in which strobe lights were used instead of the verbal messages) with the same five patients, and (c) conducted a social validation assessment of the two programs with 70 university psychology students employed as social raters. Results confirmed the effectiveness of the program with auditory cues and showed an equally strong impact of the program with light cues with all five patients. The psychology students involved in the social validation assessment provided significantly higher scores for the program involving light cues on a six-item questionnaire. Those scores suggested that this program was perceived as a practically and socially preferable choice. The implications of the findings for daily contexts dealing with patients with Alzheimer's disease are discussed.

Using iPods(®) and iPads(®) in teaching programs for individuals with developmental disabilities: a systematic review

We conducted a systematic review of studies that involved iPods(®), iPads(®), and related devices (e.g., iPhones(®)) in teaching programs for individuals with developmental disabilities. The search yielded 15 studies covering five domains: (a) academic, (b) communication, (c) employment, (d) leisure, and (e) transitioning across school settings. The 15 studies reported outcomes for 47 participants, who ranged from 4 to 27 years of age and had a diagnosis of autism spectrum disorder (ASD) and/or intellectual disability. Most studies involved the use of iPods(®) or iPads(®) and aimed to either (a) deliver instructional prompts via the iPod Touch(®) or iPad(®), or (b) teach the person to operate an iPod Touch(®) or iPad(®) to access preferred stimuli. The latter also included operating an iPod Touch(®) or an iPad(®) as a speech-generating device (SGD) to request preferred stimuli. The results of these 15 studies were largely positive, suggesting that iPods(®), iPod Touch(®), iPads(®), and related devices are viable technological aids for individuals with developmental disabilities.

Two persons with multiple disabilities use camera-based microswitch technology to control stimulation with small mouth and eyelid responses

BACKGROUND

A camera-based microswitch technology was recently developed to monitor small facial responses of persons with multiple disabilities and allow those responses to control environmental stimulation. This study assessed such a technology with 2 new participants using slight variations of previous responses.

METHOD

The technology involved a computer with a CPU using a 2GHz clock, a USB video camera with 16-mm lens, and special software. Small colour spots were used under the lower lip of one participant and on the eyelid of the other participant to aid the camera and computer to detect their mouth and eyelid responses. The study involved an ABAB design and included a 3-week post-intervention check.

RESULTS

The participants' mouth and eyelid responses increased during the intervention (B) phases and post-intervention check (i.e., when the technology allowed them to control stimulation).

CONCLUSIONS

Camera-based microswitch technology can help persons with multiple disabilities control stimulation with small responses.

Promoting adaptive behavior in persons with acquired brain injury, extensive motor and communication disabilities, and consciousness disorders

These two studies extended the evidence on the use of technology-based intervention packages to promote adaptive behavior in persons with acquired brain injury and multiple disabilities. Study I involved five participants in a minimally conscious state who were provided with intervention packages based on specific arrangements of optic, tilt, or pressure microswitches (linked to preferred environmental stimuli) and eyelid, toe and finger responses. Study II involved three participants who were emerging from a minimally conscious state and were provided with intervention packages based on computer presentations of stimulus options (i.e., preferred stimuli, functional caregiver's procedures, and non-preferred stimuli) and pressure microswitches to choose among them. Intervention data of Study I showed that the participants acquired relatively high levels of microswitch responding (thus engaging widely with preferred environmental stimuli) and kept that responding consistent except for one case. Intervention data of Study II showed that the participants were active in choosing among preferred stimuli and positive caregivers' procedures, but generally abstained from non-preferred stimuli. The results were discussed in terms of the successful use of fairly new/infrequent microswitch-response arrangements (Study I) and the profitable inclusion of functional caregiver's procedures among the options available to choice (Study II).

Technology-based programs to support forms of leisure engagement and communication for persons with multiple disabilities: two single-case studies

OBJECTIVE

To extend the assessment of technology-based programs for promoting stimulus choice and staff/caregiver calls or radio operation and text messaging.

METHOD

In Study I, the program involved a portable computer, commercial software, and a microswitch to allow a man with motor impairment and moderate intellectual disability to choose among preferred stimuli (e.g., songs and film clips) and persons to call. In Study II, the programs involved (a) a radio device and an electronic control unit or (b) a net-book computer and a global system for mobile communication. A woman with blindness and moderate intellectual disability used a microswitch to operate the radio or send and listen to text messages.

RESULTS

The participants succeeded in using the technology-aided programs through simple microswitch activations involving partial hand closure (Study I) or hand pressure (Study II).

CONCLUSION

Technology-based programs can provide persons with multiple disabilities relevant leisure and communication opportunities.

Technology-aided programs for assisting communication and leisure engagement of persons with amyotrophic lateral sclerosis: two single-case studies

Technology-aided programs for assisting communication and leisure engagement were assessed in single-case studies involving two men with amyotrophic lateral sclerosis (ALS). Study I involved a 51-year-old man with a virtually total loss of his motor repertoire and assessed a technology-aided program aimed at enabling him to (a) write and send out text messages and have incoming messages read to him and (b) establish videophone connections with his children (i.e., establish video contact and communicate with them). Study II involved a 66-year-old man with virtually no motor behavior and apparent depression and assessed a technology-aided program aimed at enabling him to (a) engage in leisure activities and make requests for basic needs and (b) use a low-demand messaging system. The results of both studies were highly encouraging. The participant of Study I could use the technology-aided program for effective communication and social interaction with multiple partners as well as for family interaction. The participant of Study II could use the technology-aided program for leisure engagement, requests, and basic family contacts/communication. The implications of technology for helping persons with severe ALS levels maintain an active and constructive role are discussed.

Speech-generating devices versus manual signing for children with developmental disabilities

We compared speed of acquisition and preference for using a speech-generating device (SGD) versus manual signing (MS) as augmentative and alternative communication (AAC) options. Four children with developmental disabilities (DD), aged 5-10 years, were taught to request preferred objects using an iPod(®)-based SGD and MS. Intervention was introduced in a multiple-probe across participants design and SGD and MS conditions were compared in an alternating treatments design. A systematic choice-making paradigm was implemented to determine if the children showed a preference for using SGD or MS. All participants showed increased use of SGD when intervention was introduced, but only three learned under the MS condition. Three participants exhibited a preference for the SGD while the remaining participant demonstrated a preference for using MS. Results support previous studies showing that individuals with DD often show a preference for different AAC options and extend previous data by suggesting that acquisition and maintenance was better for the preferred option.

Access to environmental stimulation via eyelid responses for persons with acquired brain injury and multiple disabilities: a new microswitch arrangement

This study assessed a new microswitch arrangement for eyelid responses using an optic sensor placed above the cheekbone and a small sticker on the person's eyelid. This new arrangement, which was designed to avoid interference of the microswitch with the person's visual functioning, was tested on three adults with acquired brain injury and multiple (consciousness, communication, and motor) disabilities. The study was carried out according to a non-concurrent multiple baseline design across participants. Data showed the new microswitch arrangement was suitable for all three participants, who increased their responding during the intervention phase of the study when their responses allowed them to access preferred stimulation. Practical implications of the findings are discussed.

Functional analysis of insistence on sameness in an 11-year old boy with Asperger syndrome

OBJECTIVE

To identify the functional properties of insistence on sameness associated with autism spectrum disorders.

METHOD

An 11-year-old boy with Asperger syndrome was observed during play where scenarios (mistakes, misplaced items, interrupted activity) were created to correspond with parent-reported scenarios where the child would insist on sameness. The extent of problem behaviour was observed under four functional assessment conditions (restore environment, tangible, attention, escape), according to a multi-element design.

RESULTS

The results showed an interaction between the scenario type and type of functional assessment condition. Problem behaviour appeared to have a restorative function related to correcting a mistake, an attention function related to attempting to recruit help in finding a missing item and a tangible function suggesting an attempt to regain access to the materials and activity.

CONCLUSION

Problem behaviours related to insistence on sameness may be motivated by different consequences depending on the scenario created.

A technology-aided program to support leisure engagement and communication by a man with amyotrophic lateral sclerosis

OBJECTIVE

To assess a technology-aided programme for promoting leisure engagement and communication in a man with amyotrophic lateral sclerosis (ALS).

METHOD

The programme involved a laptop computer equipped with a Clicker 5 software package, an optic microswitch and an interface device. The participant could choose between two leisure options (i.e. songs and videos), could write requests and general messages through a virtual keyboard and a microswitch and could have the written text read out to caregivers and staff.

RESULTS

The use of the programme increased the mean frequency of words written to about 15 per 20-minute session during the second intervention phase. Those words were used by the participant for formulating a mean of over two requests/messages per session. The participant also listened to songs and watched videos.

CONCLUSION

A simple technology-aided programme may allow ALS patients to manage leisure engagement and communication.

Technology-based intervention to help persons with minimally conscious state and pervasive motor disabilities perform environmentally relevant adaptive behavior

Persons with a diagnosis of minimally conscious state and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers' attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.

Persons with Alzheimer's disease make phone calls independently using a computer-aided telephone system

This study assessed whether four patients with a diagnosis of Alzheimer's disease could make independent phone calls via a computer-aided telephone system. The study was carried out according to a non-concurrent multiple baseline design across participants. All participants started with baseline during which the telephone system was not available, and continued with intervention in which such system was used. It involved a net-book computer provided with specific software, a global system for mobile communication modem (GSM), a microswitch, and photos of the persons available for the phone calls. All participants learned to use the system and made phone calls independently to a variety of partners such as family members, friends and staff personnel. The positive implications of the system were discussed in relation to previous data in this area and the possibility of helping persons with Alzheimer's disease restore an important, instrumental daily ability and engage in communication with distant partners.

Special text messaging communication systems for persons with multiple disabilities

OBJECTIVE

To expand recently-developed text messaging systems with new technology-based solutions so as to allow persons with multiple disabilities to write messages.

METHOD

Two case studies were conducted. In Study I, the new technology-based solution involved vocal scanning of the alphabet letters to allow letter selection/writing and was assessed with a woman with blindness and extensive motor disability. In Study II, the new technology-based solution involved a touch-screen superimposed on letter symbols arranged alphabetically and was assessed with a man with acquired brain injury, motor disability and lack of speech. Each study involved an ABAB design.

RESULTS

Participants learned to write their messages, to send them out and to listen to incoming messages during intervention sessions of nearly 30 and 20 minutes, respectively.

CONCLUSION

Text messaging systems can be developed that allow participants with multiple disabilities to write messages.

Persons with multiple disabilities exercise adaptive response schemes with the help of technology-based programs: three single-case studies

The present three single-case studies assessed the effectiveness of technology-based programs to help three persons with multiple disabilities exercise adaptive response schemes independently. The response schemes included (a) left and right head movements for a man who kept his head increasingly static on his wheelchair's headrest (Study I), (b) left- and right-arm movements for a woman who tended to hold both arms/hands tight against her body (Study II), and (c) touching object cues on a computer screen for a girl who rarely used her residual vision for orienting/guiding her hand responses. The technology involved microswitches/sensors to detect the response schemes and a computer/control system to record their occurrences and activate preferred stimuli contingent on them. Results showed large increases in the response schemes targeted for each of the three participants during the intervention phases of the studies. The importance of using technology-based programs as tools for enabling persons with profound and multiple disabilities to practice relevant responses independently was discussed.

Technology-based programs to improve walking behavior of persons with multiple disabilities: two single-case studies

PURPOSE

Assessing two technology-based programs for reducing toe walking and breaks during walking of two men with multiple disabilities, respectively.

METHOD

The men were involved in separate single-case studies, each of which was carried out according to an ABAB design. The technology included a microprocessor with specific software, optic sensors, and visual plus vibrotactile or auditory systems for presenting preferred stimuli. In Study I, the man received 1 s of preferred flickering lights and vibratory input for each step performed with the heel of the left foot touching the ground or coming close to it (i.e. within a 2-mm distance). In Study II, the other man received 10 s of preferred music anytime he crossed one of the small marks present along the travel routes.

RESULTS

The B phases showed that (a) the man included in Study I increased the percentages of left- and right-foot steps performed with the heels touching or nearing the ground to above 85% and 70%, respectively, and (b) the man included in Study II walked with very few breaks.

CONCLUSION

Technology-based programs can be highly effective in helping persons with multiple disabilities improve their walking behavior.

Special Education Funding Reform: A Review of Impact Studies

Various models for funding special education services have been described in the literature. This paper aims at moving the debate concerning special education funding reform beyond the descriptive level by reviewing studies that investigated the impact of various models for funding special education. Systematic searches were conducted of ERIC and PsycINFO to identify studies that investigated the impact, implications, or outcome of one or more special education funding models. Ten studies were identified covering five major funding models. The results showed that the funding reforms investigated in these studies each had associated benefits, but also potential detriments. However, these studies mainly involved indirect outcome measures, often failed to fully assess impact on academic achievement or cost-effectiveness. Results highlight the need for additional research on the impact of special education funding reform.

Post-coma persons emerged from a minimally conscious state and showing multiple disabilities learn to manage a radio-listening activity

This study assessed microswitch-based technology to enable three post-coma adults, who had emerged from a minimally conscious state but presented motor and communication disabilities, to operate a radio device. The material involved a modified radio device, a microprocessor-based electronic control unit, a personal microswitch, and an amplified MP3 player. The study was carried out according to a non-concurrent multiple baseline design across participants. During the intervention, all three participants learned to operate the radio device, changing stations and tuning on some of them longer amounts of time than on others (i.e., suggesting preferences among the topics covered by those stations). They also ended a number of sessions before the maximum length of time allowed for them had elapsed. The practical (rehabilitation) implications of the findings were discussed.

Enabling two women with blindness and additional disabilities to make phone calls independently via a computer-aided telephone system

OBJECTIVE

To assess whether two women with blindness and additional disabilities could make independent phone calls through a computer-aided telephone system.

METHOD

For each participant, the study involved an ABAB design, in which the A represented baseline phases and the B represented intervention phases with the special telephone system (involving among others a net-book computer with specific software, a global system for mobile communication modem and a microswitch).

RESULTS

Both participants learned to use the system and made phone calls independently to a variety of partners such as family members, friends and staff personnel.

CONCLUSION

The system assessed in this study might represent a useful means for enabling persons with blindness and additional disabilities to manage phone calls on their own.

Evaluation of the rate of problem behavior maintained by different reinforcers across preference assessments

The rates of problem behavior maintained by different reinforcers were evaluated across 3 preference assessment formats (i.e., paired stimulus, multiple-stimulus without replacement, and free operant). The experimenter administered each assessment format 5 times in a random order for 7 children with developmental disabilities whose problem behavior was maintained by attention, tangible items, or escape. Results demonstrated different effects related to the occurrence of problem behavior, suggesting an interaction between function of problem behavior and assessment format. Implications for practitioners are discussed with respect to assessing preferences of individuals with developmental disabilities who exhibit problem behavior.

Technology-based programs to promote walking fluency or improve foot-ground contact during walking: two case studies of adults with multiple disabilities

These two case studies assessed technology-based programs for promoting walking fluency and improving foot-ground contact during walking with a man and a woman with multiple disabilities, respectively. The man showed breaks during walking and the woman presented with toe walking. The technology used in the studies included a microprocessor with specific software, an MP3 with the recordings of preferred stimulus items, and optic sensors. Both studies were carried out according to an ABAB design. In Study I, the optic sensors were activated when the man crossed small marks distributed along the travel routes. At each sensor's activation, the man received a brief period of preferred stimulation. In Study II, the woman received preferred stimulation when the sensors at the toe and the heel of her shoes were activated in close time proximity. The man walked virtually without breaks and improved his mood (with an increase in indices of happiness) during the intervention phases of the study. The woman largely increased her percentages of steps with adequate foot-ground contact, which reached a mean of about 80 during the second intervention phase. The results were discussed in terms of rehabilitation implications and technology demands.

Technology-aided pictorial cues to support the performance of daily activities by persons with moderate Alzheimer's disease

We developed a technology-aided intervention strategy relying on pictorial cues alone or in combination with verbal instructions and assessed these two versions of the strategy with three persons with moderate Alzheimer's disease. In Section I of the study, the strategy version with pictorial cues plus verbal instructions was compared with an existing technology-based strategy with verbal instructions. Each strategy was used with one specific activity. In Section II of the study, the strategy version with pictorial cues alone was compared with the aforementioned strategy with verbal instructions. Again, each strategy was used with one activity. Both strategy versions were effective with all three participants. The percentages of correct activity performance observed with those versions increased to above 90, and were comparable with those obtained with the existing verbal instructions strategy. A social validation assessment of the version with pictorial cues alone and the existing strategy with verbal instructions (employing university psychology students as raters) showed differences in favor of the latter strategy in terms of practicality and in favor of the former in terms of respect of participants' dignity. The implications of the findings were discussed.

The influence of motivating operations on generalization probes of specific mands by children with autism

We investigated the influence of motivating operations on the generalization of newly taught mands across settings and communication partners for 3 children with autism. Two conditions were implemented prior to generalization probes. In the first condition, participants were given access to a preferred item until they rejected the item (i.e., abolishing operation). In the second condition, the item was not available to participants prior to generalization probes (i.e., establishing operation). The effects of these conditions on the generalization of newly taught mands were evaluated in a multielement design. Results indicated differentiated responding during generalization probes in which more manding with the target mand was observed following the presession no-access condition than in the presession access condition. These results support the consideration of motivating operations when assessing generalization of target mands to various untrained contexts.

Microswitch technology and contingent stimulation to promote adaptive engagement in persons with minimally conscious state: a case evaluation

This study assessed whether a post-coma woman functioning at the lower end of the minimally conscious state would (a) develop adaptive responding through the use of microswitch technology and contingent stimulation, (b) consolidate and maintain her responding over time, and (c) show evidence of response-consequences awareness (learning and discrimination). The study involved an ABABB1CB1 sequence in which the A represented baseline phases, the B and B1 intervention phases, and the C a control phase with continuous stimulation. Results indicated that the woman developed adaptive responding and consolidated it over the intervention phases of the study. The woman also showed evidence of being aware of response-consequences links. Potential implications and limitations of these findings are discussed.

A man with severe Alzheimer's disease stops wandering during a picture colouring activity

OBJECTIVE

To assess the effects of a picture colouring activity on the wandering (and constructive engagement) of a man with severe Alzheimer's disease.

METHOD

The colouring activity was compared with a music listening condition and a baseline/control condition. A choice phase involving the colouring activity and the music condition was also implemented.

RESULTS

Wandering was constant during the baseline condition, but it was reduced to low or virtually 0% levels during the music condition and picture colouring activity. Moreover, the patient regularly selected the colouring activity (which also promoted constructive engagement) during the choice phase.

CONCLUSION

Simple leisure activities, such as picture colouring, might help patients with Alzheimer's disease reduce wandering.