The Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016 statement

Grammar intervention using graduated input type variation (GITV) for pre-primary children: A single-case experimental design study

PURPOSE

This study examined the early efficacy of a new theory-driven principle of grammar intervention, graduated input type variation (GITV).

METHOD

Three Cantonese-speaking children, aged between 4;01 and 5;10, with oral language difficulties participated in this single baseline within-participant single case experimental study. The children received a total of 300 teaching episodes of the target serial verb construction via focused stimulation and recast over 10 30- to 45-minute sessions. The 30 exemplars of the target included low type variation of the verbs in each of the first five sessions, followed by high type variation in the remaining sessions.

RESULT

Visual analysis revealed that all children improved their performance in the target construction but not the control vocabulary in the probes, suggesting a treatment effect. Maintenance of treatment effects was also observed in all children. Positive results in across-behaviour generalisation to the untrained construction were observed in all children. Generalisation to other less structured linguistic contexts and to the narrative retell discourse context was minimal and observed in one child only.

CONCLUSION

Preliminary evidence suggested early efficacy of GITV as a principle for grammar intervention. Modifications in the research methodology are recommended for future studies involving children with developmental language disorder.

Increasing participation in computer activities using eye-gaze assistive technology for children with complex needs

PURPOSE

Eye-gaze assistive technology offers children with severe motor and communication difficulties the opportunity to access and control a computer through eye movements. The aim of this study was to examine the impact of eye-gaze assistive technology intervention on participation in computer activities and technology usability among children with complex needs in Taiwan.

MATERIALS AND METHODS

This study involved a multiple baseline design across individuals. The participants were four children aged three to six years with severe motor and communication difficulties and low eye-control skills. The six-month intervention consisted of two collaborative team meetings and 12 individual supports to facilitate the use of eye-gaze assistive technology at home or in educational environments. Participation in computer activities (diversity, frequency, and duration) was repeatedly measured through a computer use diary. Other outcomes included assessments of goal achievements and parents/teachers' ratings on children's performance in computer activities.

RESULTS

The young children increased the diversity of their computer activities and their frequency and duration of computer use from baseline to the intervention phase. The children attained six of eight predefined goals related to play, communication, and school learning. Parents and teachers perceived the children's changes in performance as meaningful.

CONCLUSION

This study strengthens the evidence that eye-gaze assistive technology is useful in everyday contexts for children with complex needs in Taiwan. The findings add knowledge that children with weak eye-control skills increased participation in computer activities as a result of the eye-gaze assistive technology. Implications for RehabilitationEye-gaze assistive technology (EGAT) as an access method to control a computer can provide opportunities for children with severe motor and communication difficulties to participate in computer activities.Children with severe motor and communication difficulties and low eye-control skills with sufficient practice can learn to use EGAT for communication and learning, with support from stakeholders and collaborative service.EGAT could be introduced for children with complex needs at early ages as a means of using computers for play, communication, and school learning, which could be helpful for later education and learning.Stakeholders in educational environments could include EGAT in educational computer systems so that pupils with severe motor and communication difficulties could interact with a computer, thereby enhancing their engagement and learning.

The effectiveness of aerobic versus strengthening exercise therapy in individuals with chronic whiplash-associated disorder: a randomised single case experimental design study

PURPOSE

Recent RCTs and meta-analyses compare the effectiveness of different types of exercise for chronic whiplash associated disorder (WAD). This study aimed to verify whether the results of these studies translate to statistically significant and clinically meaningful effects in individual participants.

MATERIALS AND METHODS

A series of replicated randomised single case experimental design studies (SCEDs) with A-B design (A: baseline, B: intervention). Eight participants with chronic WAD (8 female, mean [SD] age 47 [10] years) were randomised into one of four baseline durations (5, 8, 11, and 14 days) and to one of two eight-week exercise interventions (aerobic or strengthening). Daily measures of pain intensity, bothersomeness, and interference were collected during the baseline phase and the intervention phase.

RESULTS

Visual analyses indicated that three participants in the aerobic exercise group meaningfully improved. No improvements were found in the strengthening group. Effect sizes favoured the aerobic exercise group, yet randomisation tests of pooled effects did not show a difference in between-intervention effectiveness.

CONCLUSION

Contrary to our expectations, three out of four participants were nearly pain-free at the end of the aerobic exercise intervention, whereas none of the participants in the strengthening group improved meaningfully. This suggests that aerobic exercise may be favourable for WAD.Implications for RehabilitationOur results suggest that aerobic exercises are favourable over strengthening exercises and may be the preferred option for patients with chronic WAD.We found substantial variability in self-reported outcomes within participants, clinicians should be aware of this in the judgement of treatment effectiveness.

Single-case intervention research design standards: Additional proposed upgrades and future directions

Single-case intervention research design standards have evolved considerably over the past decade. These standards serve the dual role of assisting in single-case design (SCD) intervention research methodology and as guidelines for literature syntheses within a particular research domain. In a recent article (Kratochwill et al., 2021), we argued for a need to clarify key features of these standards. In this article we offer additional recommendations for SCD research and synthesis standards that have been either underdeveloped or missing in the conduct of research and in literature syntheses. Our recommendations are organized into three categories: expanding design standards, expanding evidence standards, and expanding the applications and consistency of SCDs. The recommendations we advance are for consideration for future standards, research design training, and they are especially important to guide the reporting of SCD intervention investigations as they enter the literature-synthesis phase of evidence-based practice initiatives.

Considering the implementation research-to-practice gap: An experimental evaluation of intervention-general methods for assessing and supporting intervention fidelity through coaching

Implementation support through coaching-such as with embedded fidelity assessment, performance feedback, modeling, and alliance building-has been empirically supported as a way to increase and sustain interventionists' fidelity levels. However, education research consistently shows that practitioners struggle to monitor and improve interventionists' fidelity using implementation support strategies. One explanation for this type of implementation research-to-practice gap is that evidence-based coaching strategies have significant limitations with respect to their usability, feasibility, and adaptability. This study is the first to experimentally evaluate an evidence-based set of adaptable materials and procedures designed to assess and support the intervention fidelity of school-based interventions. Using a randomized multiple-baseline-across-participants design, we examined the extent to which these materials and procedures would influence intervention adherence and quality of an evidence-based reading intervention. Across all nine interventionist participants, data revealed that the implementation strategies meaningfully improved intervention adherence and quality, and high levels of intervention fidelity maintained 1 month after removing the support procedures. Findings are discussed with respect to how these materials and procedures address a critical need within school-based research and practice as well as how they may help to inform and address the implementation research-to-practice gap in education.

Eye movement desensitization and reprocessing for post-stroke post-traumatic stress disorder: Case report using the three-phase approach

Medically-induced post-traumatic stress disorder (PTSD) is substantially more prevalent than PTSD in the general population. In people with stroke, it can impact as many as 23% of patients, with negative effects on mental health as well as stroke-related disability. Medically-induced PTSD may have unique features compared to other forms of PTSD, and therefore there is a pressing need to evaluate existing treatments for PTSD in this context. The current study reports on the feasibility, safety, and efficacy of Eye Movement Desensitization and Reprocessing (EMDR) for PTSD subsequent to a pontine stroke. Using a quasi-experimental case design, a 44-year-old Caucasian woman received EMDR delivered via telehealth. Self-report measures were obtained at baseline, pre-EMDR, and post-EMDR, with brief neuropsychological testing pre/post-EMDR. After 3 sessions of EMDR, the patient no longer met criteria for PTSD, and showed clinically significant reductions in depressive and generalized anxiety symptoms. With proper safety provisions, it is feasible to deliver EMDR via telehealth to alleviate post-stroke PTSD. Reduced linguistic demands of EMDR may be particularly appealing for persons with neurological disorders as compared to other trauma therapies. Further work is also needed to understand the parameters of baseline neuropsychological function that could impact response to intervention.

The Feasibility, Acceptability, and Efficacy of Positive Search Training for Irritable Youth: A Single-Case Experimental Design

Although irritability is common in youth, research on treatment is in its infancy. Threat biases are more pronounced in irritable compared to low irritable youth, similar to evidence found in anxious youth. Therefore, interventions targeting these biases may be promising for reducing irritability. This study utilised a multiple baseline case series design to determine the feasibility, acceptability, and efficacy of positive search training (PST) for irritable children. Three children were included who met criteria for a principal diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), and a secondary diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or Major Depressive Disorder (MDD). PST was feasible with two of the three participants; one child refused to continue after one session. For the two participants who completed PST, acceptability was stable with moderate-to-high ratings of engagement and enjoyment, and high and stable treatment-relevant verbalisations of the key strategies. Both cases showed declines in DMDD severity across treatment and no longer met criteria at post-treatment. Both participants met criteria for Oppositional Defiant Disorder (ODD) at post-treatment (considered less severe for irritability than DMDD). Declines in parent-reported irritability occurred for both cases, however some returns to baseline were observed. Overall, PST for irritable youth shows promise as an acceptable and feasible intervention. Further studies are needed combining PST with strategies for secondary diagnoses, given its high comorbidity with disruptive behaviour disorders.

A Virtual Reality Intervention to Reduce Dementia-Related Agitation Using Single-Case Design

OBJECTIVES

The primary objective of this study was to use a single-case design to evaluate the utility of a VR intervention to reduce agitation behaviors in two female participants with a diagnosis of dementia.

METHODS

A single-case research design with an ideographic approach was selected given the novelty of this intervention. A blended single case experimental design was used combining the Multiple-baseline design across individuals with a reversal design to examine the effects of VR nature scenes on agitation. Visual analysis was used to determine changes in mean, level, and latency of the behaviors.

RESULTS

For both participants, a significant decrease in their respective agitation behaviors was observed during intervention phases.

CONCLUSIONS

This study provides preliminary evidence of the utility of VR as a brief and effective intervention to decrease agitation in individuals with dementia.

CLINICAL IMPLICATIONS

These initial, promising results may help caregivers improve the quality of life for dementia patients. Further, the brevity of the intervention makes this a practical tool for care providers working in clinical settings. The primary objective of this study was to use a single-case design to evaluate the utility of a VR intervention to reduce agitation behaviors in two female participants with a diagnosis of dementia.

Single-case design standards: An update and proposed upgrades

In this paper, we provide a critique focused on the What Works Clearinghouse (WWC) Standards for Single-Case Research Design (Standards 4.1). Specifically, we (a) recommend the use of visual-analysis to verify a single-case intervention study's design standards and to examine the study's operational issues, (b) identify limitations of the design-comparable effect-size measure and discuss related statistical matters, (c) review the applicability and practicality of Standards 4.1 to single-case designs (SCDs), and (d) recommend inclusion of content pertaining to diversity, equity, and inclusion in future standards. Within the historical context of the WWC Pilot Standards for Single-Case Design (1.0), we suggest that Standards 4.1 may best serve as standards for meta-analyses of SCDs but will need to make clear distinctions among the various types of SCD studies that are included in any research synthesis. In this regard, we argue for transparency in SCD studies that meet design standards and those that do not meet design standards in any meta-analysis emanating from the WWC. The intent of these recommendations is to advance the science of SCD research both in research synthesis and in promoting evidence-based practices.

Academic and Behavior Combined Support: Evaluation of an integrated supplemental intervention for early elementary students

In current multi-tier models, students who are not responsive to universal instruction receive supplementary support. Despite most students having co-occurring academic and behavior challenges, their needs are often addressed through separate academic or behavior interventions. This approach may not only be costly for schools, but it also fails to acknowledge the well-documented link between behavior and academic performance. The purpose of this study was to evaluate Academic and Behavior Combined Support (ABC Support), a newly developed supplemental intervention that merges a combined focus on reading fluency and engagement. Six teachers implemented the intervention for 6-8 weeks with Grade 2 students. Students' oral fluency on standard and training reading passages and occurrence of engagement and disruptive behaviors during classroom reading instruction were measured repeatedly across baseline and intervention phases in a multiple-baseline design. Visual and statistical analyses revealed significant improvement from baseline to intervention for both reading and behavior outcomes. Post-intervention surveys and interviews revealed a high level of acceptability among teachers and students. Theoretical and empirical contributions as well as practice implications are addressed.

The impact of articulatory consciousness training on reading and spelling literacy in students with severe dyslexia: an experimental single case study

This study evaluates the effect of an intervention whose aim is to make articulatory consciousness a tool in decoding and spelling. The sample comprises 11 students with severe dyslexia (2 SD below the mean pseudoword scores), and the intervention programme consists of 32 individual sessions over 8 weeks. The study applies a multiple baseline/probe design with five baseline tests that correspond to a control condition, eight tests during the intervention and five post-intervention tests. On average, the results show significant improvement in all reading and spelling outcomes. However, there were also significant effects on an irrelevant control task (the pegboard test), perhaps indicating testing effects on the dependent variables, making it difficult to draw firm conclusions from the study. Consequently, testing the intervention in randomised trials of children with severe dyslexia is recommended to draw more firm conclusions about its efficacy for this group.

A Storytelling Approach on Vocabulary, Reading, and Letter Sound Fluency of Struggling First Graders With German as Second Language With and Without Behavioral Problems

The number of students learning German as a second language (L2) is steadily increasing. Unfortunately, studies reveal that less-proficient school performance affects a larger proportion of these students and additional behavioral problems can create even greater learning barriers. In order to master a language, the focus is not only on vocabulary, but also on reading, and studies show that multi-component intervention in reading and L2 acquisition is particularly promising. Therefore, this multiple baseline study focuses on a multi-component storytelling intervention on vocabulary, reading, and letter sound fluency of low-achieving first graders with German as L2 with and without behavioral problems (N = 7). The intervention was implemented 3 times a week over a 6-week period. Results show significant large to very large effects on vocabulary and moderate to large effects on letter sound fluency and reading, providing indication for the positive impact of storytelling on multiple aspects simultaneously for the focused sample.

Comparing Biofeedback Types for Children With Residual /ɹ/ Errors in American English: A Single-Case Randomization Design

Purpose Research comparing different biofeedback types could lead to individualized treatments for those with residual speech errors. This study examines within-treatment response to ultrasound and visual-acoustic biofeedback, as well as generalization to untrained words, for errors affecting the American English rhotic /ɹ/. We investigated whether some children demonstrated greater improvement in /ɹ/ during ultrasound or visual-acoustic biofeedback. Each participant received both biofeedback types. Individual predictors of treatment response (i.e., age, auditory-perceptual skill, oral somatosensory skill, and growth mindset) were also explored. Method Seven children ages 9-16 years with residual rhotic errors participated in 10 treatment visits. Each visit consisted of two conditions: 45 min of ultrasound biofeedback and 45 min of visual-acoustic biofeedback. The order of biofeedback conditions was randomized within a single-case experimental design. Acquisition of /ɹ/ was evaluated through acoustic measurements (normalized F3-F2 difference) of selected nonbiofeedback productions during practice. Generalization of /ɹ/ was evaluated through acoustic measurements and perceptual ratings of pretreatment/posttreatment probes. Results Five participants demonstrated acquisition of practiced words during the combined treatment package. Three participants demonstrated a clinically significant degree of generalization to untreated words on posttreatment probes. Randomization tests indicated one participant demonstrated a significant advantage for visual-acoustic over ultrasound biofeedback. Participants' auditory-perceptual acuity on an /ɹ/-/w/ identification task was identified as a possible correlate of generalization following treatment. Conclusions Most participants did not demonstrate a statistically significant difference in acoustic productions between the ultrasound and visual-acoustic conditions, but one participant showed greater improvement in /ɹ/ during visual-acoustic biofeedback. Supplemental Material https://doi.org/10.23641/asha.14881101.

The Immediate Effect of Parachute-Resisted Gallop on Heart Rate, Running Speed and Stride Frequency in Dogs

Simple Summary

Physical fitness is needed for canine athletes and working dogs to optimize their performance in various disciplines. Application of resistance on movements causes biomechanical and cardiorespiratory responses to physical exercise. However, there is still a lack of research on the effects of high-intensity resistance exercise on cardiorespiratory fitness components such as heart rate in canine athletes. In this article, we investigate the short-term effects of parachute-resisted galloping on heart rate, running speed and stride frequency. Healthy dogs of various breeds were extensively studied in five experimental single cases. The dogs ran on a straight 200 m course with and without resistive drag force applied by a parachute attached to their harness while heart rate, running speed and stride frequency were measured. Subsequently, the measurements were compared to baseline phases at rest. In the present trials we found that heart rate increases similarly with and without parachute-resistance while dogs galloped at lower speeds and with increased stride frequency with applied drag force. Our findings lead us to suggest that parachute-resisted galloping is a clinically applicable exercise in healthy dogs to achieve instant cardiorespiratory response.

Abstract

Physical fitness is required for canine athletes and working dogs to optimize performance in various disciplines. There is a lack of research on the effects of resistance exercise on cardiorespiratory variables in dogs. The aim of this study was to investigate the immediate effects of parachute-resisted (PR) gallop on heart rate, running speed and stride frequency compared to unresisted (UR) gallop in dogs. Five N-of-1 trials RCTs with alternating interventions were implemented. Dogs ran on a 200 m course with and without resistive force applied by a parachute attached to their harness while cardiac inter-beat intervals (IBI), running speed and stride frequency were measured. The results were visually displayed and interpreted in graphs and percentage of non-overlapping data estimated effect size. Both interventions showed large effects on heart rate compared to resting values. Mean IBI increased (10–17%) during PR gallop compared to UR gallop although this change was small relative to decreased running speed (19–40%) and increased stride frequency (18–63%). Minimum IBI showed no difference between interventions indicating similar maximum heartbeat per minute. In conclusion, parachute-resistance resulted in dogs galloping at lower speeds at the same cardiorespiratory level of intensity, which may be useful in canine physical rehabilitation and fitness training.

Assessing Consistency in Single-Case Data Features Using Modified Brinley Plots

The current text deals with the assessment of consistency of data features from experimentally similar phases and consistency of effects in single-case experimental designs. Although consistency is frequently mentioned as a critical feature, few quantifications have been proposed so far: namely, under the acronyms CONDAP (consistency of data patterns in similar phases) and CONEFF (consistency of effects). Whereas CONDAP allows assessing the consistency of data patterns, the proposals made here focus on the consistency of data features such as level, trend, and variability, as represented by summary measures (mean, ordinary least squares slope, and standard deviation, respectively). The assessment of consistency of effect is also made in terms of these three data features, while also including the study of the consistency of an immediate effect (if expected). The summary measures are represented as points on a modified Brinley plot and their similarity is assessed via quantifications of distance. Both absolute and relative measures of consistency are proposed: the former expressed in the same measurement units as the outcome variable and the latter as a percentage. Illustrations with real data sets (multiple baseline, ABAB, and alternating treatments designs) show the wide applicability of the proposals. We developed a user-friendly website to offer both the graphical representations and the quantifications.

Evaluation of an occupation-based metacognitive intervention targeting awareness, executive function and goal-related outcomes after traumatic brain injury using single-case experimental design methodology

Self-awareness is commonly impaired after traumatic brain injury and impacts on rehabilitation engagement and community re-integration outcomes. Interventions which incorporate metacognitive strategy instruction have the potential to improve rehabilitation engagement and outcomes. This study aimed to determine whether an occupation-based intervention incorporating metacognitive strategy instruction resulted in goal achievement and improved online awareness and executive function performance during goal-related tasks. A single-case experimental design using a multiple-baseline design across behaviours was used with two participants with severe traumatic brain injury to evaluate the effectiveness of the 6-week intervention. Repeated measures of goal-related performance, percentage of self-corrected errors and executive function were made via independent analysis of video footage and documentation logs. Data analysis involved 2SD bandwidth analysis and overlap data, reliable change index and evaluation of goal achievement across phases. There were improvements in self-corrected errors for one participant, which were maintained. Significant reductions in anxiety (RCI = ±5.98) were evident for both participants, with a significant reduction in stress (RCI = ±7.05) for one participant following the intervention. The occupation-based intervention incorporating metacognitive strategy instruction led to improvements compared to baseline performance in some targeted goals, online awareness and executive function performance during goal-related tasks and reduced stress and anxiety.

Assessing consistency of effects when applying multilevel models to single-case data

In the context of single-case experimental designs, replication is crucial. On the one hand, the replication of the basic effect within a study is necessary for demonstrating experimental control. On the other hand, replication across studies is required for establishing the generality of the intervention effect. Moreover, the "replicability crisis" presents a more general context further emphasizing the need for assessing consistency in replications. In the current text, we focus on replication of effects within a study, and we specifically discuss the consistency of effects. Our proposal for assessing the consistency of effects refers to one of the promising data analytical techniques, multilevel models, also known as hierarchical linear models or mixed effects models. One option is to check, for each case in a multiple-baseline design, whether the confidence interval for the individual treatment effect excludes zero. This is relevant for assessing whether the effect is replicated as being non-null. However, we consider that it is more relevant and informative to assess, for each case, whether the confidence interval for the random effects includes zero (i.e., whether the fixed effect estimate is a plausible value for each individual effect). This is relevant for assessing whether the effect is consistent in size, with the additional requirement that the fixed effect itself is different from zero. The proposal for assessing consistency is illustrated with real data and is implemented in free user-friendly software.

Toward guidelines for reporting assistive technology device outcomes

PURPOSE

The aim of this study was to develop and pilot-test reporting guidelines for manuscripts describing studies of assistive technology device outcomes, with the hopes of improving the overall quality of research in this field.

METHODS

The research is presented in two stages. In Stage 1, a literature review was completed to identify the essential components of a conceptual framework for reporting guidelines and to create a checklist. In Stage 2, two independent reviewers evaluated twenty articles using the checklist to identify any short-comings of the tool and produce an estimate of interrater reliability. Two items of the original checklist were revised after reconciling disagreements between the two raters.

RESULTS

The Cohen's Kappa value of the checklist was 0.887 (p < .000), reflecting excellent interrater agreement. The overall percent agreement was 94.6%.

CONCLUSIONS

Reporting guidelines for studies of assistive technology device outcomes appear to be reliable. Although the checklist may require periodic updating, it has potential for advancing outcomes research. Researchers are invited to share comments and criticisms to aid in the efforts of enhancing the quality of reporting in this field.Implications for rehabilitationReporting checklists and guidelines are effective tools for achieving a minimum standard of reporting quality in all areas of rehabilitation research.This study presents a preliminary reporting checklist for the field of assistive technology device outcomes that has potential for advancing outcomes research.Authors and journal editors are encouraged to adopt and adhere to reporting guidelines in order to enhance the clarity and completeness of prospective studies.

Single-Case Design, Analysis, and Quality Assessment for Intervention Research

BACKGROUND AND PURPOSE

The purpose of this article is to describe single-case studies and contrast them with case studies and randomized clinical trials. We highlight current research designs, analysis techniques, and quality appraisal tools relevant for single-case rehabilitation research.

SUMMARY OF KEY POINTS

Single-case studies can provide a viable alternative to large group studies such as randomized clinical trials. Single-case studies involve repeated measures and manipulation of an independent variable. They can be designed to have strong internal validity for assessing causal relationships between interventions and outcomes, as well as external validity for generalizability of results, particularly when the study designs incorporate replication, randomization, and multiple participants. Single-case studies should not be confused with case studies/series (ie, case reports), which are reports of clinical management of a patient or a small series of patients.

RECOMMENDATIONS FOR CLINICAL PRACTICE

When rigorously designed, single-case studies can be particularly useful experimental designs in a variety of situations, such as when research resources are limited, studied conditions have low incidences, or when examining effects of novel or expensive interventions. Readers will be directed to examples from the published literature in which these techniques have been discussed, evaluated for quality, and implemented.

Speech therapy in adolescents with Down syndrome: In pursuit of communication as a fundamental human right

PURPOSE

The achievement of speech intelligibility by persons with Down syndrome facilitates their participation in society. Denial of speech therapy services by virtue of low cognitive skills is a violation of their fundamental human rights as proclaimed in the Universal Declaration of Human Rights in general and in Article 19 in particular. Here, we describe the differential response of an adolescent with Down syndrome to three speech therapy interventions and demonstrate the use of a single subject randomisation design to identify effective treatments for children with complex communication disorders.

METHOD

Over six weeks, 18 speech therapy sessions were provided with treatment conditions randomly assigned to targets and sessions within weeks, specifically comparing auditory-motor integration prepractice and phonological planning prepractice to a control condition that included no prepractice. All treatments involved high intensity practice of nonsense word targets paired with tangible referents.

RESULT

A measure of generalisation from taught words to untaught real words in phrases revealed superior learning in the auditory-motor integration condition.

CONCLUSION

The intervention outcomes may serve to justify the provision of appropriate supports to persons with Down syndrome so that they may achieve their full potential to receive information and express themselves.

A microswitch-based program for promoting initial ambulation responses: An evaluation with two girls with multiple disabilities

We assessed the use of a microswitch-based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid.