Effects of ambient stimuli on measures of behavioral state and microswitch use in adults with profound multiple impairments

Eye-tracking-based experimental paradigm to assess social-emotional abilities in young individuals with profound intellectual and multiple disabilities

Individuals with Profound Intellectual and Multiple Disabilities (PIMD) experience a combination of severe cognitive and motor impairments frequently associated with additional sensory deficits and numerous medical disorders. The purpose of the present study was to propose an experimental paradigm based on eye-tracking that combines various pre-existing tasks from infancy research as an assessment tool. This would enable the investigation of social-emotional abilities in nine young individuals with PIMD through their visual preferences for different types of stimuli. The first objective was to test the feasibility of this paradigm, by expecting individuals to look more at the tasks’ presentation screen than elsewhere during its implementation. The second objective was to investigate whether PIMD individuals exhibit visual preferences for (a) biological (vs. non-biological) motion, (b) socially salient (vs. non-social) scenes, (c) the facial area of the eyes (vs. the mouth), (d) happy (vs. angry) faces, (e) objects of joint attention (vs. non-looked at ones), and for (f) prosocial (vs. anti-social) behaviors similar to those of a control group of typically developing children aged two years on average. Overall, the feasibility of this paradigm proved to be good, resulting in high individual looking rates that were not affected by the presentation or the content of the tasks. Analyses of individual social-emotional abilities, supported by the visual preference patterns of each PIMD individual, firstly revealed strong—but expected—variability both within and between subjects, and secondly highlighted some individual task-specific abilities although few similarities between these individual results and those of the control group were found. These findings underline the great relevance of using this type of paradigm for assessing PIMD individuals and thus contribute to a better understanding of their social and emotional development.

Assessing a Microswitch-Based Stimulation Procedure for Eye-Blinking Responses in a Young Woman with Profound Multiple Disabilities

We applied a new microswitch-based stimulation procedure for eye-blinking responses with a young woman with profound multiple disabilities, and compared effects of this procedure on the eye-blinking responses and smiling with the effects of a caregiver-based stimulation condition. Analysis showed that the microswitch-based stimulation procedure, with stimulation occurring contingent on eye-blinking responses, increased the frequencies of these responses significantly above the levels recorded in baseline and caregiver-based stimulation conditions. No changes in smiling frequencies occurred. Implications of the findings in terms of alertness, learning, and quality of life are discussed.

Small Hand-Closure Movements Used as a Response through Microswitch Technology by Persons with Multiple Disabilities and Minimal Motor Behavior

This study assessed small hand-closure movements as a potential response for microswitch activation with two participants with profound multiple disabilities of 5.2 and 20.6 yr. of age. The microswitch consisted of a two-membrane thin pad fixed to the palm of the hand and a control system. The outer membrane (the one facing the fingers) was a touch-sensitive layer; the inner membrane was activated if the participant applied a pressure of over 20 gm. The activation of either membrane triggered an electronic control system, which in turn activated one or more preferred stimuli for 6 sec. except in baseline phases. Each participant received an ABAB sequence, in which A represented baseline and B intervention phases, and a 1-mo. postintervention check. Analysis showed both participants increased their responding during the intervention phases and maintained that responding at the postintervention check. Implications of the findings are discussed.

Microswitch-aided programs with contingent stimulation versus general stimulation programs for post-coma persons with multiple disabilities

OBJECTIVE

Assessing the impact of microswitch-aided programs with contingent stimulation on response engagement (Study I) and post-session alertness (Study II) of post-coma participants with multiple disabilities.

METHOD

Study I included three participants whose scores on the Coma Recovery Scale-Revised (CRS-R) were 11 or 13. Study II included three participants whose CRS-R scores were 19, 13, and 14. In both studies, the participants received sessions with contingent stimulation (i.e., sessions in which activation of a microswitch with an eyelid or hand response produced 15 s of preferred stimulation) and sessions with general, non-contingent stimulation (i.e., stimulation lasted throughout the sessions).

RESULTS

Study I showed an increase in response engagement/frequencies only during the contingent stimulation sessions. Study II showed that the participants' level of vigilance after those sessions was higher than after non-contingent stimulation sessions.

CONCLUSION

Microswitch-aided programs with contingent stimulation would be more beneficial than programs with general/non-contingent stimulation.

Beyond behavioural observations: a deeper view through the sensory reactions of children with profound intellectual and multiple disabilities

BACKGROUND

The present study was aimed at assessing the behavioural and physiological responsiveness of three children with profound intellectual and multiple disabilities to a set of sensory stimuli.

METHODS

Eighteen items, 'believed' by clinicians to be appropriate for routine interventions, were presented to the participants and responsiveness was assessed in terms of: (i) consistent behavioural and electrodermal reactions and (ii) biphasic changes in heart rate.

RESULTS

Results were twofold. First, all participants showed frequent consistent physiological reactions but rare consistent behavioural ones. Second, all participants showed biphasic changes in heart rate, pointing to the possibility of different appraisals (novelty and pleasantness) of most of the presented items.

CONCLUSIONS

Data here presented may have implications for the development and the emotional well-being of individuals with profound intellectual and multiple disabilities in that it suggests that reactions to, and potential appraisals of, sensory stimuli may occur despite the lack of consistent observable behaviours.

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.

Alertness in individuals with profound intellectual and multiple disabilities: a literature review

Direct support persons (DSPs) often face problems in observing and determining alertness in individuals with profound intellectual and multiple disabilities (PIMD). A literature study was carried out to gather information about the problems just described. A search of two electronic databases and the references found in relevant hits revealed 42 relevant publications. The results show that two types of descriptions of alertness can be distinguished: (1) those with a focus on the individual only or (2) those with a focus on the interaction of individual and environment. Several observation categories were used in the studies that were found. The reliability of the observations turned out to be a core problem in most of the studies. Only a limited number of environmental conditions that were expected to have an impact on alertness in individuals with PIMD were investigated. While modifications of the environment, interaction strategies, stimulation strategies and staff training were found to have a positive impact on alertness, studies about treatment activities led to conflicting results. Finally, we will formulate the resulting implications for future studies and for the development of an instrument for DSPs in order to observe alertness in individuals with PIMD in clinical practice.

Two boys with multiple disabilities increasing adaptive responding and curbing dystonic/spastic behavior via a microswitch-based program

A recent study has shown that microswitch clusters (i.e., combinations of microswitches) and contingent stimulation could be used to increase adaptive responding and reduce dystonic/spastic behavior in two children with multiple disabilities [Lancioni, G. E., Singh, N. N., Oliva, D., Scalini, L., & Groeneweg, J. (2003). Microswitch clusters to enhance non-spastic response schemes with students with multiple disabilities. Disability and Rehabilitation, 25, 301-304]. The present study was an attempt to replicate the aforementioned study with two boys with multiple disabilities. The adaptive responses selected for the boys consisted of pushing an object with the hand or the back. The dystonic/spastic behavior consisted of body arching (i.e., pushing belly and stomach forward) and leg stretching for the two boys, respectively. Initially, the boys received preferred stimulation for all hand- and back-pushing responses. Subsequently, the stimulation followed only the responses that occurred free from the dystonic/spastic behavior. The results showed that both boys increased the frequency of adaptive responses, learned to perform these responses free from the dystonic/spastic behavior, and maintained this improved performance during a 2-month post-intervention check.

Microswitch-Based Programs for Persons with Multiple Disabilities: An Overview of Some Recent Developments

Persons with multiple disabilities are often unable to interact with their environment due to their limited response repertoire. Microswitch programs are designed to help them control environmental events, generally preferred stimulation, through simple (feasible) responses. To make microswitch programs a more widely usable and relevant resource for intervention with these persons, a number of new developments were pursued in recent years. This paper examines three of those developments as specifically addressed in our research activity, namely, (a) assessment of new, nontypical responses and matching microswitches, (b) fostering of multiple responses and exercise of choice, and (c) targeting of habilitative and clinical (therapeutic) objectives. The encouraging outcomes of these developments are reviewed in relation to their potentially wide implications for daily practice and the need of additional developments in the area.

Three persons with multiple disabilities accessing environmental stimuli and asking for social contact through microswitch and VOCA technology

BACKGROUND

Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregiver's attention.

METHODS

Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three.

RESULTS

The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available.

CONCLUSIONS

Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.

Enabling two persons with multiple disabilities to access environmental stimuli and ask for social contact through microswitches and a VOCA

This study assessed the combination of two microswitches with a voice output communication aid (VOCA) with two persons (an adolescent and a young adult) with multiple disabilities. The microswitches allowed the participants to obtain direct access to preferred environmental stimuli; the VOCA enabled them to ask for caregiver's attention. Initially, the participants were taught to use each of the two microswitches individually and then together. Next, they were taught to use the VOCA and, eventually, this was available together with the microswitches. Results showed that the participants learned to operate the microswitches and the VOCA and used all three of them consistently when they were simultaneously available. Implications of these findings and the potential role of a VOCA combined with conventional microswitches were discussed.

Persons with multiple disabilities and minimal motor behavior using small forehead movements and new microswitch technology to control environmental stimuli

Persons with multiple disabilities and minimal motor behavior may be unable to use available microswitch technology to control environmental stimuli. For these persons, one may need to rely on small motor expressions (as responses) and new, matching microswitch technology to ensure a successful outcome. In the present study, a small movement of the forehead skin was selected as the response for two participants (ages 6.5 and 14.2 years) with profound multiple disabilities. The microswitch technology included (a) an optic sensor, i.e., barcode reader, (b) a small tag with horizontal bars attached to the participants' forehead, and (c) an electronic control system which activated stimuli in relation to response occurrence. Movement of the forehead skin shifted up or down the tag with bars and this shifting, if greater than a preset limit and therefore recorded as a response, led to the activation of the control system. Each participant received an ABAB sequence, in which A represented baseline and B intervention phases, and a 6-wk. postintervention check. Analysis showed both participants increased their responding during the intervention phases and maintained that responding at the postintervention check. Implications of the findings were discussed.

Extending the Evaluation of Novel Microswitch Technology for Small Responses in Children With Profound Multiple Disabilities

This study extended the evaluation of microswitch technology (i.e., a position sensor and an optic device), recently introduced for chin and eyelid responses, with two new participants with profound multiple disabilities. The participants were girls of 12.5 and 4.0 years of age who did not possess any specific response that they could profitably use in their environment. The study was conducted according to an ABAB design with a 3-week postintervention check. The results showed that both participants increased their level of responding during the intervention phases and postintervention check compared to the baseline phases. This positive outcome was discussed in terms of (a) the apparent suitability of the technology and responses used in the study, (b) the beneficial implications for the participants, and (c) new developments in the area.

Assessing the effects of stimulation versus microswitch-based programmes on indices of happiness of students with multiple disabilities

BACKGROUND

Stimulation and microswitch-based programmes are considered main strategies to promote indices of happiness in students with multiple disabilities. However, only limited attempts have been made to assess the relative effects of the two programmes. This study conducted such an assessment with seven students with multiple disabilities.

METHODS

The first four phases of the study served to: (1) provide the students with a systematic exposure to each of the programmes; and (2) measure the programmes' effects on indices of happiness by comparing them with baseline levels. The fifth phase served to compare the programmes with each other.

RESULTS

The first four phases of the study showed that the microswitch-based programme produced a significant increase in indices of happiness for all seven students, and the stimulation programme produced a significant increase for six students. During the fifth phase of the study (i.e. when the two programmes were alternated), the microswitch-based programme promoted significantly higher indices of happiness than the stimulation programme for four of the seven students.

CONCLUSIONS

Microswitch-based programmes might be deemed preferable to stimulation programmes because they can promote higher or comparable indices of happiness while promoting the acquisition of adaptive responses and self-determination.

Microswitch programs for persons with multiple disabilities: an overview of the responses adopted for microswitch activation

BACKGROUND

To introduce a person with multiple disabilities to a microswitch-aided program, one has to select a plausible response(s), that is, a response(s) that can be performed reliably and without excessive effort by the person and can successfully activate the microswitch(es) available (producing preferred stimuli). This paper provides an overview of the responses adopted for microswitch activation in research studies during the last 20 years.

METHOD

Computerized and manual searches were carried out to identify the studies published between 1986 and 2005. Forty-eight research studies were identified. They concerned the use of (1) a single (typical) response, (2) a single (non-typical) response, (3) multiple (typical and non-typical) responses, and (4) multiple (vocal) responses.

RESULTS AND DISCUSSION

The results showed that 151 of the 190 participants involved in the studies had a positive outcome (i.e., clear increases in their responding, which suggested that they had learned the association between responding and consequent preferred stimuli). Failures were largely concentrated in the first group of studies. The discussion focused on (a) the importance of selecting plausible responses for increasing the chances of success, (b) the need of non-typical responses for persons with minimal motor behavior, (c) implications of programs with multiple responses on engagement and choice, and (d) relevance of using vocal utterances. Some suggestions for future research concerning these points were also examined.

A novel method for testing learning and preferences in people with minimal motor movement

Ten individuals with profound multiple impairments were given novel tests for learning and preference with adaptive switches and leisure-oriented devices, such as audio tape players. Typically, tests for learning include a baseline or extinction component in which the adaptive switch and device are not connected as a control for incidental or involuntary switch use. As an alternative, conditions were compared in sets of six sessions each in which switch closure caused (a) Activation of a device, (b) Deactivation of an already operating device, and (c) Deactivation of one of two devices and Activation of the other (Two-Choice). Changes in behavior indicative of learning were observed in eight participants in Activation-Deactivation conditions. The Two-Choice Condition produced indices of learning that also showed a preference for one device over the other with five participants. The preferences observed in the Two-Choice Condition had not been seen in the Activation or Deactivation Condition data. People with profound multiple impairments evinced leisure-device preferences, but such preferences may not lead to differential responding across opportunities with only one device at a time.