Assistive technology for promoting choice behaviors in three children with cerebral palsy and severe communication impairments

The application of the family of participation-related constructs (fPRC) framework to AAC intervention outcomes in children with complex communication needs: a scoping review

Participation is a fundamental human right, and being able to communicate is an essential component of participation in various life situations, such as at school, with peers, and in the community. Augmentative and alternative communication (AAC) interventions aim to facilitate communication and social interaction, independence, and participation in all aspects of life. The purpose of this study was to summarize and map the AAC intervention outcomes for children with complex communication needs onto the Family of Participation-Related Constructs (fPRC) framework. The scoping review identified 270 studies for inclusion, and the data gathered was extracted and mapped onto the fPRC framework. The results indicate that although many studies have reported on participation-related constructs such as activity competence and context, there is still insufficient focus on attendance and involvement, sense of self, and environment constructs. Hence, future research in the field of AAC is needed on the various constructs of participation proposed by the fPRC framework.

Caregiver-reported impact of access to switch-adapted toys on play for children with complex medical conditions

BACKGROUND

Play is essential for children's development of motor, social-emotional and cognitive skills. Traditional play activities are often difficult for children with complex medical conditions to access, which threatens their ability to maximize their developmental potential. Switch-adapted toys are a common strategy for expanding the play repertoire of children with disabilities by lowering the barrier to play with electronic toys. The aim of this study is to investigate the relationship between providing switch-adapted toys to children with disabilities and the children's total and self-initiated play time and access to a variety of cognition-appropriate toys, age-appropriate toys and independently accessible toys as reported by their caregivers.

METHODS

Caregivers and their children with complex medical conditions were provided switch-adapted toys at a giveaway event. At the giveaway event and 6 months later, caregivers completed a survey that included questions about each child's current participation in play and their type of play, child's access to toys and questions specific to switches and switch-adapted toys. Data were analysed using Wilcoxon signed-rank tests with a Benjamini-Hochberg procedure to control for multiple comparisons.

RESULTS

Nineteen caregivers completed both the pre- and post-surveys. The increases in the variety of toys and the number of independently accessibly and cognitively appropriate toys were statistically significant. The change in number of age-appropriate toys and the amount of total and active play time were not statistically significant.

CONCLUSIONS

Providing switch-adapted toys may be an effective way to increase the number of independently accessible and cognitively appropriate toys for children with complex medical conditions. However, increasing the number of such toys may not be sufficient to increase active and total play time. Further research is needed to identify variables impacting play time and distal outcomes associated with switch-adapted toy access.

A practitioner's guide to emphasizing choice-making opportunities in behavioral services provided to individuals with intellectual and developmental disabilities

Promoting choice is a defining value guiding Positive Behavior Support (PBS) models for serving individuals with intellectual and/or developmental disabilities (IDD). The ability to make independent choices is of paramount importance to self-advocacy and self-determination. Promoting choice is also an essential commitment of trauma-informed care (TIC) in the provision of services to vulnerable individuals, as trauma often involves experiences in which an individual has no control over aversive events that occur, and choice-making opportunities can empower traumatized individuals to regain control over the environments they routinely encounter. However, incorporating meaningful choice making into behavioral programming is often more difficult than it seems. We synthesize the relevant, contemporary literature to provide professionals with actionable suggestions for incorporating choice making into everyday behavioral services. After summarizing the importance of promoting choice into behavioral services based on the values that define both PBS and TIC frameworks, we (a) offer a behavior-analytic interpretation of the skill of making choices, (b) synthesize key literature on how to teach choice making skills, (c) provide recommendations for the situations within one's care in which choice-making opportunities may be most beneficial, and (d) discuss some of the barriers and potential solutions to incorporating choice-making opportunities for individuals with IDD.

Effects of Interventions Involving Speech Output Technologies on Communication Outcomes for Individuals With Developmental Disabilities: A Scoping Review

PURPOSE

This scoping review aimed to map the literature on the effects of interventions involving speech output technologies on communication outcomes for individuals with developmental disabilities other than autism spectrum disorder.

METHOD

A scoping review methodology was used to limit bias in searching, selecting, coding, and synthesizing relevant intervention studies. This involved a multifaceted search for studies conducted between 1991 and March 2021 using various electronic databases, ancestry searches, and forward citation searches from selected articles. Studies had to meet stringent inclusion criteria. Each study was summarized in terms of authors, purpose, participants, design, speech output, outcomes, effectiveness, and quality appraisal.

RESULTS

Twenty-five single-case experimental design studies (88 participants) and one group design studies (62 participants) qualified for inclusion. Most of the participants had multiple diagnoses followed by a diagnosis of cerebral palsy and Down syndrome. Most studies focused on requesting behaviors and to a much lesser extent on syntactic structure and word identification. A dearth of high-quality studies was identified.

CONCLUSIONS

Overall, there is a paucity of high-quality research investigating the effects of speech output technologies for children with developmental disabilities. Additionally, several directions for future research are posited.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20468928.

Psychological eHealth interventions for people with intellectual disabilities: A scoping review

BACKGROUND

The use of eHealth, which has accelerated in the wake of the COVID-19 pandemic, could contribute to the access to tailor-made psychological interventions for people with intellectual disabilities.

METHOD

A scoping review was conducted on peer-reviewed studies between 1996-2019.

RESULTS

Thirty-three studies reported on the use of psychological eHealth interventions focused on mental health problems and/or challenging behaviour. The vast majority of these studies reported on interventions that were delivered at the individual level. The context in which these interventions were delivered varied, primarily ranging from the home setting to residential settings, as well as day or activity centres and schools. The studies described various types of interventions: telehealth interventions, computerized cognitive behavioural therapy, and interventions focused on (social) learning principles targeting challenging behaviour.

CONCLUSIONS

eHealth provides new opportunities for both therapists and lay-therapists to deliver psychological interventions. Future studies should focus on the effectiveness of psychological eHealth interventions.

Direct assessment of emotional well-being from children with severe motor and communication impairment: a systematic review

PURPOSE

Explore methods used in peer-reviewed literature for obtaining self-expression of well-being information from children with severe motor and communication impairment (SMCI).

MATERIALS AND METHODS

A comprehensive search was conducted on 22 August 2019 through academic databases: CINAHL; Embase; MEDLINE; PsycINFO; InSpec; Compendex. Search strategies were informed by keywords under the following areas: (1) population: children with SMCI, (2) assessment methods: alternative to natural speech, paper and pencil report or standardized keyboard use (e.g., eye gaze) and (3) target information: well-being (e.g., quality of life). Studies were excluded if they focused on individuals over 25-years old, exclusively autism or typically developing children.

RESULTS

Non-duplicate studies of 10,986 were screened; 49 studies met inclusion criteria. Most studies used high-tech methods of self-expression in a single context (n = 17). Familiar partners play a significant role in self-expression; 18 studies required a familiar partner for children with SMCI to self-express. Thirty-five studies involved children self-expressing to solely adults, in comparison to 14 studies which involved peers.

CONCLUSION

Findings highlight the advancement of high-tech communication devices restricted to application in single contexts. Familiar partner knowledge of children with SMCI has the potential to be shared with others (e.g., respite care providers), enhancing both caregiver and child well-being. Future research that would enhance the literature could explore the assessment of emotional well-being for application in various contexts using multimodal methods. Opportunities for children with SMCI to express their emotional well-being can further influence the understanding and enhancement of participation, social connections, and experiences.IMPLICATIONS FOR REHABILITATIONUse of lower tech methods of self-expression to obtain information directly from children with severe motor and communication impairment (SMCI) remain more feasible in home and school contexts.By utilizing familiar partners' experiences and knowledge of the child, respite care providers, novel support workers, and others involved in the lives of children with SMCI can become further informed.Current high-tech methods for obtaining the emotional expressions of children with SMCI may benefit from incorporating multimodal approaches including lower tech methods, to be feasibly applied in real world contexts where well-being takes place.Further research on this topic is imperative to enable children with SMCI to self-express their emotional well-being which can enhance participation, activities, social connections, and experiences.

Facilitators and Barriers of Assistive Technology and Learning Environment for Children with Special Needs

The purpose of this research was to study the facilitators and barriers of assistive technology (AT) and the learning environment for children with special needs in special education schools in Chiang Mai, Thailand. The informants were one hundred and sixteen children with special needs, who studied in nursery to Grade 12, or with their caregivers. The instrument was a questionnaire applied by the International Classification of Functioning, Disability and Health (ICF) and examined for content validity by five specialists. The results in terms of AT showed that a majority of children with physical disability needed it for mobility and use of school buildings and those with hearing disability for communication. However, most of the children did not need to use AT for culture, recreation, or sports, while many considered it as a facilitator for education. In terms of the learning environment, most characteristics of the physical environment were facilitators for children with special needs, as were those of the social environment for all groups of such children. The results of this study were useful in providing information for AT and design of a learning environment relating to the varied characteristics of children with special needs in special education schools.

Case series of technology-aided interventions to support leisure and communication in extensive disabilities

Objectives: This study assessed a new technology-aided program to support independent leisure and communication engagement with people with intellectual and motor or sensory-motor disabilities. Methods: Six adults participated. The program relied on the use of a Samsung Galaxy Tab S2 LTE tablet with Android 6.0 Operating System, a NANO SIM card, and the WhatsApp Messenger and MacroDroid applications. The participants were presented with leisure and communication (i.e. text messaging) alternatives, and, based on their choices, with series of steps allowing them to access leisure events or send messages. Results: During baseline, the participants were unable to access leisure events or send messages. During intervention and post-intervention phases, they used the program successfully and spent large percentages of the session time independently engaged in leisure and messaging. Conclusions: A program based on readily available technology may be functional to support leisure and communication in people like the participants of this study.

Autonomy Benefits and Risks of Assistive Technologies for Persons With Intellectual and Developmental Disabilities

This paper explores the ways in which assistive technologies (ATs) can both promote and undermine the autonomy of Persons with Intellectual and Developmental Disabilities (PIDD). Following an initial discussion of ATs for PIDD, I examine the specific issues of autonomy for PIDD. I outline the ways in which ATs can boost autonomy, of PIDD, focusing on knowledge, authenticity, and liberty. Following that I suggest that ATs are not necessarily beneficial in terms of autonomy and examine ways that they might be used to undermine the autonomy of PIDD, specifically the categories of knowledge, authenticity, and liberty. I conclude by suggesting that the development of ATs requires ethical oversight.

Assistive technology to promote occupation and reduce mouthing by three boys with fragile X syndrome

OBJECTIVES

To extend the use of assistive technology (AT) for promoting a new adaptive response and to reduce hand mouthing, by three boys with fragile X syndrome. To monitor the effects of the intervention program on the positive mood. To carry out a three month follow-up phases. To conduct a social validation assessment involving 30 parents of children who presented multiple disabilities as raters.

METHODS

The study was implemented according to an ABAB experimental design, where A represented baseline phases (technology available but inactive) and B represented intervention phases (the technology ensured 7 s of positive stimulation).

RESULTS

All participants improved and consolidated their performance. Parents involved in the social validation assessment rated positively the use of such technology.

CONCLUSION

AT-based program was useful, affordable, and effective for enhancing constructive engagement, self-determination, and for improving quality of life by children with fragile X syndrome and severe to profound developmental disabilities.

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.

Technological aids to support choice strategies by three girls with Rett syndrome

This study was aimed at extending the use of assistive technology (i.e., photocells, interface and personal computer) to support choice strategies by three girls with Rett syndrome and severe to profound developmental disabilities. A second purpose of the study was to reduce stereotypic behaviors exhibited by the participants involved (i.e., body rocking, hand washing and hand mouthing). Finally, a third goal of the study was to monitor the effects of such program on the participants' indices of happiness. The study was carried out according to a multiple probe design across responses for each participant. Results showed that the three girls increased the adaptive responses and decreased the stereotyped behaviors during intervention phases compared to baseline. Moreover, during intervention phases, the indices of happiness augmented for each girl as well. Clinical, psychological and rehabilitative implications of the findings are discussed.

Technological supports to promote choice opportunities by two children with fragile X syndrome and severe to profound developmental disabilities

This study was aimed at assessing whether technological supports (i.e. optic sensors such as photocells) were successful enabling two boys with fragile X syndrome and severe to profound developmental disabilities to perform occupation and choice opportunities. A second goal of the study was to reduce stereotyped behaviours (i.e. hand mouthing and eye poking) exhibited by the participants. Finally, the third purpose of the study was to verify the rehabilitative effects of the intervention program on the indices of happiness of the participants. The study has been conducted according to a non-concurrent multiple baseline design across participants followed by intervention and cross over phases, where the associations between behavioural responses and environmental consequences were systematically inverted. Moreover, a maintenance phase was assessed. The results demonstrated that the technology is useful to facilitate employment and opportunities of choice, showing a growth of the indices of happiness and a decrease of stereotyped behaviours, from both participants involved. Clinical, practical and psychological implications of the findings are discussed.

Assistive technology-based programs to promote communication and leisure activities by three children emerged from a minimal conscious state

This study proposed the use of assistive technology (AT) to promote communication and leisure opportunities by three children with traumatic brain injury (TBI). Furthermore, it assessed the effects of such technology on the indices of positive participation and provided a social validation procedure. Three children emerged from a minimal conscious state and presenting extensive motor disabilities were involved. The intervention program allowed the participants to request and to choice preferred items independently and to perform literacy through a keyboard emulator. A multiple probe design across behaviors with post-intervention check was employed. Outcome measures were correct requests, understandable words, intervals with positive participation, and scores of social validation assessment. Request and choice behaviors and literacy improved significantly during intervention phases. During post-intervention check, all participants consolidated their performance. Moreover, indices of positive participation increased during intervention phases. Scores of social validation assessment showed that the combination of both behaviors was preferable to the same considered separately. AT program showed to be suitable for promoting constructive engagement and literacy behaviors by children with TBI. Future research is needed to generalize this data to a larger sample and to develop new technology for people with different levels of disabilities due to TBI.