An Environmental Enrichment Programme to Promote Adaptive Responding in Two Children with Multiple Disabilities

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.

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.