Extending microswitch-based programs for people with multiple disabilities: use of words and choice opportunities

A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications

Individuals with multiple disabilities are among the most challenging to serve and AAC teams often lack direction in determining effective interventions. The purpose of this scoping review was to summarize the research evidence on AAC interventions for individuals with complex communication needs and simultaneous motor, and visual impairments as part of their multiple disabilities; to consider implications for practice; and to determine gaps and directions for future research. A total of 27 studies were identified and reviewed, involving 55 unique participants with multiple disabilities. Most studies focused on direct intervention to increase requesting or choice-making, with little focus on social communication. Only two studies focused on training communication partners. Results indicated that AAC interventions can be highly effective to increase communication for individuals with multiple disabilities. However, there is an urgent need for increased rigor and more detailed participant information in future AAC intervention research with this population. Future research should investigate AAC intervention to improve social communication and increase language development, not just expression of needs and wants. Future research should focus on the needs of individuals with multiple disabilities from culturally and linguistically diverse backgrounds and on implementation of AAC within natural environments.

A new movement detector to enable people with multiple disabilities to control environmental stimulation with hand swing through a commercial mouse

This study assessed whether two persons with profound multiple disabilities would be able to control environmental stimulation using hand swing and a standard mouse with a newly developed mouse driver (i.e. a new mouse driver replaces standard mouse driver, and turns a mouse into a precise two-dimensional motion detector). The study was performed according to an ABAB design and included a 2-month post-intervention check. Data showed that both participants significantly increased their target response (hand swing) to activate the control system to produce environmental stimulation during the B (intervention) phases. This performance was maintained at the post-intervention check. Practical and developmental implications of the findings were discussed.

Assisting people with multiple disabilities and minimal motor behavior to control environmental stimulation through a mouse wheel

This study assessed whether two people with profound multiple disabilities and minimal motor behavior would be able to control environmental stimulation using thumb poke ability with a mouse wheel and a newly developed mouse driver (i.e., a new mouse driver replacing standard mouse driver, and turning a mouse into a precise thumb poke detector). The study was carried out according to an ABAB design and included a 2-month post-intervention check. The two people increased significantly in the target response (thumb poke) to activate the control system to produce environmental stimulation during the B (intervention) phases. This performance was maintained at the post-intervention check. Practical and developmental implications of the findings were discussed.

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.

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.

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.

Enabling students with multiple disabilities to request and choose among environmental stimuli through microswitch and computer technology

This study assessed the possibility of enabling two students with multiple disabilities to request and choose among environmental stimuli through microswitch and computer technology. Each student was provided with two basic microswitches the activation of which made a computer system present a sample of a preferred or non-preferred stimulus. The student could select or reject such a stimulus by vocal utterances discriminated by the computer system as 'yes' or 'no'. If the student selected the stimulus, the computer system presented it for a preset time. If the student rejected the stimulus, the computer system waited for the next input of one of the basic microswitches. Data showed that both students learned to activate the basic microswitches consistently, selected the preferred stimuli about 90% of the times, and largely rejected the non-preferred stimuli. The students also showed some preferences between the two basic microswitches/responses. The performance was maintained at the post-intervention checks carried out 3 and 6 weeks after the end of the intervention. Implications of the findings are discussed technically, practically, and in terms of quality of life.

Extending the evaluation of a computer system used as a microswitch for word utterances of persons with multiple disabilities

BACKGROUND

Micro-switches can be vital tools to help individuals with extensive multiple disabilities acquire control of environmental stimulation. This study was aimed at extending the evaluation of a computer system used as a microswitch for word utterances with three participants with multiple disabilities.

METHOD

Sets of 7 or 12 word utterances were used for the participants. The utterances were divided into three groups, which were exposed to intervention successively. During the intervention and a 2-month post-intervention check, the participants' emission of the target utterances led the system to present favourite, matching stimuli (i.e. provided that it recognized the utterances).

RESULTS

Intervention data showed that (1) the participants increased the frequencies of the target utterances and (2) the computer system recognized approximately 80% of those utterances. These findings were maintained at the post-intervention check. An analysis of the levels of occurrence of individual utterances showed statistically significant differences among them, in line with the notions of preference and choice.

CONCLUSIONS

The computer system was useful as a microswitch to enable access to favourite stimuli. There is a need to improve the accuracy of the system with respect to its recognition of the participants' utterances.

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.

Microswitch clusters to support responding and appropriate posture of students with multiple disabilities: three case evaluations

PURPOSE

This study extended the evaluation of microswitch clusters to support responding and appropriate posture with three students with multiple disabilities.

METHOD

Initially, a baseline level was established for the target response selected for each student. Then, Intervention I was implemented to increase the frequency of that response through the presentation of favourite stimuli. During Intervention II, the response was followed by favourite stimuli only if the microswitch cluster detected it in combination with appropriate posture. Post-intervention checks were carried out within 2 or 3 months from the end of Intervention II.

RESULTS AND CONCLUSIONS

All students showed an increase in the frequency of the target response during Intervention I and in the percentage of times the response occurred in combination with appropriate posture during Intervention II. These changes lasted over time. The importance of microswitch clusters to enhance the performance of students with multiple disabilities was underlined.

A microswitch program including words and choice opportunities for students with multiple disabilities

Two students with multiple disabilities were provided with two or three request microswitches and one choice microswitch. Activation of a request microswitch triggered the verbal announcement of one of the stimulus events related to it. The student could choose such an event through the choice microswitch or bypass it. The request microswitches were introduced individually and made available simultaneously by the end of the intervention and the postintervention period. Analysis showed that both students learned to use the microswitches. Transfer of the microswitch program into the students' home was very successful with one student and presented some difficulties with the other. Implications of the findings and new possible developments were discussed.

Using computer systems as microswitches for vocal utterances of persons with multiple disabilities

We assessed the effects of two computer systems used as microswitches for the vocal utterances of an adolescent and a young adult with multiple disabilities. The systems were to respond to three one-syllable utterances of the first participant and nine word-like utterances of the second participant by presenting favorite stimuli linked to those utterances. The computer system used for the first participant relied on a software program developed specifically for this study. The computer system used for the second participant combined a new software program with a commercially available speech recognition program. Results showed that both participants increased the frequencies of their target utterances and obtained high levels of stimulation. Positive performance was maintained at post-intervention checks. Technical and practical implications of the data are discussed.