A microswitch to enable a woman with acquired brain injury and profound multiple disabilities to access environmental stimulation with lip movements

This study assessed a new type of microswitch designed to enable a woman with acquired brain injury and profound multiple disabilities to access environmental stimulation through lip movements. The microswitch involved two optic sensors aimed at detecting changes in lip positions. Data showed that the microswitch was suitable and functional for the participant who increased her responding (lip movements) during the intervention phases of the study, that is, when her responses allowed her to access preferred stimulation. Practical implications of the findings were discussed.

Post-coma persons with motor and communication/consciousness impairments choose among environmental stimuli and request stimulus repetitions via assistive technology

This study assessed whether a program based on microswitch and computer technology would enable three post-coma participants (adults) with motor and communication/consciousness impairments to choose among environmental stimuli and request their repetition whenever they so desired. Within each session, 16 stimuli (12 preferred and 4 non-preferred) were scheduled for the participants. For each stimulus, a computer system provided a sample of a 3-s duration. During the intervention, participants' responding (e.g., eye blinking and hand closure) in relation to a stimulus sample activated a microswitch and led the computer system to turn on that stimulus for 20 s. Participants' lack of responding led the computer system to pause briefly and then present the next scheduled stimulus sample. When participants responded immediately after (i.e., within 6s from) the end of a stimulus presentation, that stimulus was repeated. Intervention data showed response increases, which were very consistent for two participants and moderate for the third one. All participants asked for the repetition of preferred stimuli and showed minimal responding in relation to non-preferred stimuli. The results were discussed in light of their possible implications for new, person-centered rehabilitation programs for post-coma persons with multiple disabilities.

Promoting ambulation responses among children with multiple disabilities through walkers and microswitches with contingent stimuli

Children with severe or profound intellectual and motor disabilities often present problems of balance and ambulation and spend much of their time sitting or lying, with negative consequences for their development and social status. Recent research has shown the possibility of using a walker (support) device and microswitches with preferred stimuli to promote ambulation with these children. This study served as a replication of the aforementioned research and involved five new children with multiple disabilities. For four children, the study involved an ABAB design. For the fifth child, only an AB sequence was used. All children succeeded in increasing their frequencies of step responses during the B (intervention) phase(s) of the study, although the overall frequencies of those responses varied largely across them. These findings support the positive evidence already available about the effectiveness of this intervention approach in motivating and promoting children's ambulation. Practical implications of the findings are discussed.

Helping a man with multiple disabilities to use single vs repeated performance of simple motor schemes as different responses

A man with multiple disabilities was taught to use single vs repeated performance of simple motor schemes as different responses. Specifically, single and double emissions of a finger movement served as two separate responses, which allowed direct access to different environmental stimuli via microswitch technology. Single and double emissions of a head movement served as two additional responses, which allowed interaction with two different caregivers who were called via voice output communication aids (VOCAs). The results showed that the man, who had pervasive motor impairment, acquired the four responses available and seemed to use them purposefully. The implications of this approach to increase the response options of persons with few controllable motor schemes were discussed.

Two persons with multiple disabilities use orientation technology with auditory cues to manage simple indoor traveling

This study was an effort to extend the evaluation of orientation technology for promoting independent indoor traveling in persons with multiple disabilities. Two participants (adults) were included, who were to travel to activity destinations within occupational settings. The orientation system involved (a) cueing sources only at the destinations (i.e., a single sound source per destination), (b) a newly developed electronic control device that allowed the participants to easily manage the activation of the sources at the destinations, and (c) the provision of approval or encouragement messages. Both participants were successful in using the system and performed their travels to the destinations fairly correctly and in relatively short amounts of time within (a) the occupational setting used for the intervention and (b) a similar occupational setting used for checking generalization effects. The findings are discussed in relation to the importance of independent indoor traveling and the impact of the new technology.

A technology-based stimulation program to reduce hand mouthing by an adolescent with multiple disabilities

This study assessed the possibility of reducing hand mouthing, i.e., bringing fingers into or over the mouth, by an adolescent with multiple disabilities through a technology-based stimulation strategy. The strategy ensured that (a) the participant received 10 sec. of preferred stimulation contingent on the response of bringing both hands into a box with objects, and (b) the stimulation would be interrupted prematurely if the participant removed one or both hands from the box for 2 sec. The study involved an ABAB sequence (in which A represented baseline and B intervention phases) and a 3-mo. postintervention check. Data showed that the response of bringing both hands into the box increased from a mean frequency of about four per 10-min. session during baseline to a mean frequency of over 30 per session during the second intervention phase and the postintervention check. During these periods, the participant's mean hand-mouthing time per session was below 1.5 min. (compared to above 7 min. during baseline) and the mean stimulation time per session was about 4 min. Practical implications of the findings are discussed.

Microswitch- and VOCA-assisted programs for two post-coma persons with minimally conscious state and pervasive motor disabilities

Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with minimally conscious state and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music intervals, and (b) a voice output communication aid (VOCA) with two channels, activated via different hand-closure movements, which allowed the man to call his mother and a research assistant who provided stimulation events. Study II assessed a program that included (a) a pressure microswitch, activated via head movements, which allowed a man direct access to video-clips and music, and (b) a VOCA device, activated via prolonged eyelid closure, which allowed the man to call the caregiver (i.e., a research assistant) who provided attention and sung to him. Each of the two participants had significant increases in both microswitch- and VOCA-related responses during the intervention phases of the studies. Moreover, purposeful choice seemed to occur between the two VOCA responses in Study I. Implications of the findings for improving the situation of post-coma persons with minimally conscious state and pervasive motor disabilities are discussed.

Two persons with multiple disabilities use a mouth-drying response to reduce the effects of their drooling

These two studies involved a boy and a man with multiple disabilities, who were taught to use a mouth-drying response to reduce the effects of their drooling. Both studies relied on microswitch technology to monitor the drying response and follow it with positive stimulation (i.e., during intervention). In Study I, the boy performed the drying response via a special napkin. The microswitch technology consisted of touch/pressure sensors and a radio transmitter hidden inside the napkin. Drying responses led the boy to 8s of preferred stimulation. In Study II, the man performed the drying response via a handkerchief. The microswitch technology consisted of an optic sensor and a radio transmitter at the man's chest. Drying responses led the man to 8-10s of preferred stimulation. The stimulation time/conditions were subsequently modified to promote a reduction in the man's response frequency. The experimental design involved an ABAB sequence (Study I) or an ABABB(1)B(2) sequence (Study II), with the second B or the B(1)B(2) combination spreading over periods of about 3 months. The results indicated vast increases in drying responses and decreases in chin wetness during the intervention phases. The frequencies of the drying response remained consistent for the boy and stabilized at a lower level (i.e., in line with the manipulation of the stimulation conditions) for the man. Implications of the findings and limitations of the studies are discussed.

A technology-assisted learning setup as assessment supplement for three persons with a diagnosis of post-coma vegetative state and pervasive motor impairment

Post-coma persons in an apparent condition of vegetative state and pervasive motor impairment pose serious problems in terms of assessment and intervention options. A technology-based learning assessment procedure might serve for them as a diagnostic supplement with possible implications for rehabilitation intervention. The learning assessment procedure adopted in this study relied on hand-closure and eye-blinking responses and on microswitch technology to detect such responses and to present stimuli. Three participants were involved in the study. The technology consisted of a touch/pressure sensor fixed on the hand or an optic sensor mounted on an eyeglasses' frame, which were combined with a control system linked to stimulus sources. The study adopted an ABABCB sequence, in which A represented baseline periods, B intervention periods with stimuli contingent on the responses, and C a control condition with stimuli presented non-contingently. Data showed that the level of responding during the B phases was significantly higher than the levels observed during the A phases as well as the C phase for two of the three participants (i.e., indicating clear signs of learning by them). Learning might be deemed to represent basic levels of knowledge/consciousness. Thus, detecting signs of learning might help one revise a previous diagnosis of vegetative state with wide implications for rehabilitation perspectives.

Persons with multiple disabilities accessing stimulation and requesting social contact via microswitch and VOCA devices: new research evaluation and social validation

The first of these two studies assessed whether 11 participants with multiple disabilities of 5.3-18.2 (M=10.7) years of age would succeed in combining a microswitch for accessing preferred environmental stimuli and a Voice Output Communication Aid (VOCA) for requesting social contact. The second study conducted a social validation assessment of the aforementioned microswitch-VOCA combination. Data showed that all participants learned to use the microswitch and the VOCA. Moreover, the 10 participants, who received a 1-month post-intervention check, largely maintained their responding. The social validation assessment indicated that the raters (i.e., 110 university psychology students) favored the combination of microswitch and VOCA over the microswitch or the VOCA alone, and hypothetical combinations of microswitches or VOCAs.

An optic micro-switch for an eyelid response to foster environmental control in children with minimal motor behaviour

This study assessed whether two children (11.9- and 9.7-years-old) with profound multiple disabilities and minimal motor behaviour could learn to control environmental stimulation using an eyelid response with a newly developed micro-switch. The response consisted of raising the eyelid markedly (i.e. by looking upward or opening the eyes widely). The micro-switch developed for this target response consisted of an electronically regulated optic sensor mounted on an eyeglasses' frame. Data showed that the children learned the target eyelid response to activate the micro-switch and to increase their level of environmental stimulation. Responding was largely maintained at a 2-month post-intervention check. These results indicate that continued work in this area has positive implications for the rehabilitation of children with most serious disabilities.

Micro-switch clusters to enhance hand responses and appropriate head position in two children with multiple disabilities

This study evaluated the use of micro-switch clusters to improve response activity and posture with two children with multiple disabilities. The children were first taught a hand response and then required to combine this response with appropriate head position. The micro-switch clusters adopted for this purpose consisted of a pressure or mercury micro-switch for the hand response combined with a mercury micro-switch for the head position. Both children had an increase in the frequency of the hand response and in the percentage of times this occurred in combination with appropriate head position. These changes were maintained at a 2-month post-intervention check.

Evaluating a computer system used as a microswitch for word utterances of persons with multiple disabilities

PURPOSE

To assess the effectiveness of a computer system used as a microswitch for word utterances of two adults with multiple disabilities. The system combined a new control software programme with a commercially available speech recognition programme.

METHOD

Nine word utterances were targeted for each participant. The participant's emission of those utterances triggered the occurrence of related (favourite) stimuli during the intervention and the post-intervention check.

RESULTS

Intervention data showed that (1) the participants increased the frequencies of the target utterances and (2) the computer system recognized about 80% of those utterances correctly, providing the participants with high levels of favourite stimulation. The post-intervention check showed comparable data with both participants.

CONCLUSIONS

The computer system proved an adequate microswitch for word utterances. Based on this evidence, microswitch programmes could be extended beyond the use of conventional motor responses.

An overview of research on increasing indices of happiness of people with severe/profound intellectual and multiple disabilities

PURPOSE

This paper was to provide an overview of research studies aimed at increasing indices of happiness of persons with severe/profound intellectual and multiple disabilities.

METHODS

Computerized and manual searches were carried out to identify the studies published from 1990 to 2004 (i.e., the period during which the issues of quality fo life and happiness in people with disabilities have become more prominent). Twenty-four research studies were identified. They involved the use of six different procedures, that is, structured stimulation sessions, microswitch-based simulation sessions, leisure activities and favourite work tasks or conditions, positive environment or positive behaviour support programmes and mindful caregiving, favourite stimulation automatically delivered on exercise engagement, and snoezelen.

RESULTS AND CONCLUSION

Data tended to be positive with increases in the participants' indices of happiness, but some failures also occurred. The outcomes were discussed in relation to (a) methodological issues, such as designs of the studies, length of the intervention, and number of participants, and (b) personal and practical implications of the procedures. Some suggestions for future research (particularly focused on extending evidence and overcoming present methodological weakness) were also examined.

Microswitch clusters to enhance adaptive responses and head control: A programme extension for three children with multiple disabilities

PURPOSE

We assessed the possibility of extending adaptive responding and head control in three children with multiple disabilities through the use of microswitch clusters.

METHOD

The children had previously learned to perform an adaptive hand response and to control head position during that response. They were now taught one or two new adaptive responses (foot lifting, leg touching, or vocalization) and to combine such responses with appropriate head position. Microswitch clusters served to ensure that an adaptive response was followed by positive stimulation only if it was combined with appropriate head position.

RESULTS

The results were positive with the children learning the new adaptive responses and combining them with appropriate head position. This performance was maintained during two- or three-month post-intervention checks. During these checks, the children were also successful in using the old adaptive hand response with appropriate head position.

CONCLUSIONS

The use of microswitch clusters was effective to extend the level of adaptive responding and enhance appropriate head position during this responding. This outcome, which indicates a successful technical replication and procedural extension of previous work in the area, has positive practical implications for educational and occupational programmes for children with multiple disabilities.

Enabling a person with multiple disabilities and minimal motor behaviour to control environmental stimulation with chin movements

PURPOSE

To assess whether a young man with multiple disabilities and minimal motor behaviour would learn to control environmental stimulation using chin movements and a mechanical microswitch.

METHOD

The study was carried out according to an ABAB design in which A represented baseline and B intervention phases. The chin movements controlled the stimulation only during the intervention phases. A 2-month post-intervention check was conducted.

RESULTS

The man increased the frequency of his chin movements, thus increasing the level of environmental stimulation, during the intervention phases. This performance was maintained at the post-intervention check.

CONCLUSION

The use of chin movements is a practical strategy for enabling individuals with minimal motor movements to control environmental stimulation. Future research should examine whether similar types of movements may enable some individuals to control voice-output communication devices.

Upgraded technology for contingent stimulation of mouth wiping by two persons with drooling and profound developmental disabilities

Many persons with developmental and physical disabilities experience drooling (i.e., loss of saliva from the mouth). Technology was recently developed to help two of these persons reduce the negative effects of drooling by increasing mouth-wiping responses. This study upgraded our initial approach and tested it with the two persons who we previously treated. Upgrading ensured that all technology components, including the stimulation sources, were on the participant's body and that stimulation for mouth wiping caused no (or limited) environmental disturbance. We also conducted a social validation assessment of the new technology and its effects, employing university students as social raters. Evidence showed that the participants used the upgraded technology successfully in settings attended by varieties of other persons. The university students involved in the social validation viewed the use of the technology as enjoyable, beneficial, and environmentally acceptable, and they largely supported it.

Students with multiple disabilities using technology-based programs to choose and access stimulus events alone or with caregiver participation

The first of these two studies extended preliminary evidence on the use of technology-based programs for enabling students with severe and profound multiple disabilities to choose and access environmental stimuli on their own. Each of the three participants had two microswitches linked to specific sets of stimuli through a computer system. The activation of one of the microswitches triggered the computer system to present a sample of one of the stimuli. If the student chose it, the computer system turned it on for a specific time interval. The second study tested a new technology that allowed the students to choose and access the chosen stimuli with the involvement of the caregiver. The two participants had three microswitches linked to a computer system. The participants' choice of a stimulus alerted the caregiver who then got involved in the stimulation process. The results of both studies showed that the participants learned to activate the basic microswitches consistently, had high percentages of choice for the stimulus samples presented by the computer but with wide differences across stimuli, and largely maintained this performance at a 2-month post-intervention check. These findings were analyzed in terms of the usability of the two types of programs, the role they may play within educational and living contexts, and their innovative technical dimensions.

Practical guidelines for the use of new generation antipsychotic drugs (except clozapine) in adult individuals with intellectual disabilities

New generation antipsychotic (NGA) drugs introduced to the US market after clozapine (aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone) are frequently used in individuals with intellectual disabilities (ID). However, there is very limited research to fully establish evidence-based or personalized medicine approaches for their use in this population. These guidelines take a pragmatic approach to establishing frameworks for their use by utilizing the prescribing information and reviewing the available literature on other relevant neuropsychiatric disorders. In the absence of expert consensus guidance and well-controlled comparison trials, we present a set of guidelines to inform initiation, dosing and monitoring of use in adults. Further, in these guidelines we provide practical information on drug-drug interactions and adverse drug reactions, and a brief review of discontinuation syndromes, potential for abuse, use during pregnancy and cost considerations. We also provide drug utilization review forms for each NGA to facilitate implementation of these guidelines, these guidelines provide a practical and necessary resource for practitioners treating psychiatric disorders and challenging behaviors in adult individuals with ID.