Staff interactive style during multisensory storytelling with persons with profound intellectual and multiple disabilities

Rethinking empathy: professional work with persons with PIMD

This article combines ethnographic interpretations with analyses of the conceptual history of empathy. Moving beyond the more common notions, which often rely in psychological theories and terminologies, the conceptual-historical analyses trace its roots to 18th and 19th century notions of 'Einfühlung'. As the ethnographic work follows the professional work with two young women with profound intellectual and multiple disabilities, the article makes a fivefold argument. First, we argue that empathy is often considered a matter of individual cognition but should be rethought as an embodied process of feeling-into. Second, we argue that this process is characterised by incompleteness-and hence must acknowledge that empathy is always partial, always on the way to understanding. Third, we argue that this incompleteness forces us to think about the underlying 'connecting force', and that the conceptual history suggests that we should think about this force as a form of love. Fourth, we suggest that this 'love' is highly embodied, and that this suggests that theoretical notions of empathy should relate to notions of kinship. Fifth, we suggest that the combination of this love (affection, appreciation), embodied kinship and incompleteness suggests a final rethinking, namely the notion of empathy as a form of longing.

A trained communication partner’s use of responsive strategies in aided communication with three adults with Rett syndrome: A case report

Purpose

To explore and describe a trained communication partner’s use of responsive strategies in dyadic interaction with adults with Rett syndrome.

Introduction

Responsive partner strategies facilitate social, communicative, and linguistic development. The common feature is that the communication partner responds contingently to the other’s focus of attention and interprets their acts as communicative. Research on responsive partner strategies that involves individuals with significant communication and motor disabilities remains sparse. The same applies to if, and how, the use of communication aids impacts on the partner’s use of responsive strategies.

Materials and methods

A therapist, trained in responsive partner strategies and aided communication interacted during 14 sessions with each of three participants. The participants were adults with Rett syndrome. A gaze-controlled device and responsive strategies were used during all sessions. The Responsive Augmentative and Alternative Communication Style scale (RAACS) was used to assess the partner’s responsiveness. RAACS consists of 11 items including ratings of to what extent the partner is being attentive to, confirms, and expands the individual’s communication. During eight of the 14 sessions, aided AAC Modelling was also used, i.e., the communication partner pointed at symbols on the gaze-controlled device while interacting. In addition to RAACS, each time the communication partner confirmed or expanded on communication when (a) the participants used the gaze-controlled device and (b) the participants did not use the gaze-controlled device was counted. Descriptive statistics were used to present the results. Non-parametric tests were used to compare means between the two conditions and between participants.

Results

Inter-rater agreement for the different RAACS items ranged from 0.73 to 0.96 and was thus found to be fair to excellent. The communication partner’s use of responsive strategies varied when communicating with different participants and the scores were higher when aided AAC modeling was used. The communication partner’s number of responses and use of responsive strategies were higher when the participants communicated through a gaze-controlled device.

Conclusion

The communication partner’s use of responsive and scaffolding strategies is not a fixed construct but varies in interactions with different non-speaking persons. The same is true whether the non-speaking person uses a gaze-controlled device with digitized speech or not.

Persons with intellectual and multiple disabilities activate via non-verbal responses a smartphone's Google Assistant to access preferred stimulation

OBJECTIVES

The present study evaluated a new smartphone-based program to help 12 participants with intellectual disability plus visual and motor impairments to self-regulate their stimulation input (thus avoiding their dependence on staff) through simple non-verbal responses.

METHOD

Nonconcurrent multiple baseline designs across participants were used to assess the effects of the program. The technology used for the program involved a Samsung J4 Plus smartphone with Android 9.0 operating system, two voice recording devices, smart-plugs, and a mini speaker. The smartphone was provided with a Google account and Internet connection, which allowed the participants to access Google Assistant and Google Play Music. The participants could make requests for two different types of stimulation (e.g. songs and familiar voices or noises) by activating via hand pressure the two voice recording devices. The verbal request messages emitted by the devices were recognized by the Google Assistant, which led the smartphone to deliver the related stimulation.

RESULTS

During the baseline sessions (without the support of the voice recording devices), the participants failed to access any stimulation. During the intervention and post-intervention phases (with the support of the voice recording devices), all participants managed to access the types of stimulation available independently. The mean frequency of responses (i.e. activations of both voice recording devices) per session ranged between about 8 and 14.

CONCLUSION

The new smartphone-based program can be viewed as a useful resource to enable individuals like the participants of this study to access preferred stimulation independently.

Factors predicting school staff's responsivity toward students with intellectual and developmental disability and complex communication needs

BACKGROUND

Children with significant intellectual and developmental disabilities (IDD) are characterized by substantial language delays. Responsivity, the quantity and quality of the communication partner's responses to child's behaviors, is a key component in communication development.

AIMS

The aim of the study was to map multidimensional factors predicting school staff's responsivity toward communication of students with IDD with complex communication needs.

METHOD

Interactions between 120 school staff members and 43 students ages 9-16, were videotaped, during group and individual routine sessions in school. Staff's behaviors were transcribed and coded to form responsivity scores. Statistical tests were performed to map variables predicting staff's responsivity.

RESULTS

Analysis revealed the type of session (individual/group) as a main predictor of responsivity. Separate analysis of individual and group sessions revealed that while in the individual session students' speech level was the main predictor for responsivity, in group sessions, group size, number of sessions per week, staff's attitudes and students' disability level were among the variables predicting responsivity.

CONCLUSIONS

Results emphasize group setting as more complex where multidimensional factors influence the communication process, whereas students' speech ability is important in promoting staff's responsivity in individual sessions. Implications for designing conditions to promote responsivity are discussed.

Making a difference? A comparison between multi-sensory and regular storytelling for persons with profound intellectual and multiple disabilities

BACKGROUND

Multi-sensory storytelling (MSST) was developed to include persons with profound intellectual and multiple disabilities in storytelling culture. In order to increase the listeners' attention, MSST stories are individualised and use multiple sensory stimuli to support the verbal text. In order to determine the value of MSST, this study compared listeners' attention under two conditions: (1) being read MSST books and (2) being read regular stories.

METHOD

A non-randomised control study was executed in which the intervention group read MSST books (n = 45) and a comparison group (n = 31) read regular books. Books were read 10 times during a 5-week period. The 1st, 5th and 10th storytelling sessions were recorded on video in both groups, and the percentage of attention directed to the book and/or stimuli and to the storyteller was scored by a trained and independent rater. Two repeated measure analyses (with the storytelling condition as a between-subject factor and the three measurements as factor) were performed to determine the difference between the groups in terms of attention directed to the book/stimuli (first analysis) and storyteller (second analysis). A further analysis established whether the level of attention changed between the reading sessions and whether there was an interaction effect between the repetition of the book and the storytelling condition.

RESULTS

The attention directed to the book and/or the stimuli was significantly higher in the MSST group than in the comparison group. No significant difference between the two groups was found in the attention directed to the storyteller. For MSST stories, most attention was observed during the fifth reading session, while for regular stories, the fifth session gained least attentiveness from the listener.

CONCLUSION

The persons with profound intellectual and multiple disabilities paid more attention to the book and/or stimuli in the MSST condition compared with the regular story telling group. Being more attentive towards the book and stimuli might give persons with PIMD the opportunity to apprehend the story and to be included in storytelling culture.

Developing the personal narratives of children with complex communication needs associated with intellectual disabilities: What is the potential of Storysharing® ?

BACKGROUND

Sharing personal experience in narrative is challenging for individuals with intellectual disabilities. The aim was to investigate the potential of Storysharing^® (Storysharing is an innovative communication method based on personal narrative, which has been developed to support conversations with people who have severe difficulties in communication) intervention.

MATERIALS AND METHODS

The study involved eleven pupil-educational supporter dyads at a special school. Storysharing^® was implemented over a 15-week period. Personal narratives were captured on video pre- and post-intervention. The data were analysed for discourse and narrative.

RESULTS

Significant differences revealed a decline in 'query-answer' sequences and an increase in supporter use of 'prompts'. After intervention, there were fewer story episodes. Narrative structure showed gains in action sequences leading to climax, and in closing elements, indicating a more complete narrative.

CONCLUSIONS

The Storysharing^® intervention appears to be associated with changes to the dyadic, personal narratives illustrating its potential.

Speech and language therapists' approaches to communication intervention with children and adults with profound and multiple learning disability

BACKGROUND

People with profound intellectual and multiple disabilities (PMLD) have communication impairments as one defining characteristic.

AIMS

To explore speech and language therapists' (SLTs) decision making in communication interventions for people with PMLD, in terms of the intervention approaches used, the factors informing the decisions to use specific interventions and the extent to which the rationales underpinning these decisions related to the components of evidence based practice (EBP), namely empirical evidence, clinical experience and client/carer views and values.

METHODS & PROCEDURES

A questionnaire on communication assessment and intervention for people with PMLD was sent to SLTs in the UK to elicit information on: the communication intervention approaches they used; their rationales for their intervention choices; their use of published evidence to inform decision making.

OUTCOMES & RESULTS

Intensive interaction and objects of reference were the communication interventions most often used with people with PMLD, with some differences between children and adults evident. Rationales provided conformed somewhat to the EBP framework though extension of the existing framework and addition of practical and organizational considerations led to a revised typology of rationale for decision making. Rationales most frequently related to the empowerment, development and behavioural preferences of the person with PMLD.

CONCLUSIONS & IMPLICATIONS

Empirical research evidence was seldom mentioned by SLTs as informing intervention decision making leading to very diverse practice. There is a need for further research on the effectiveness of commonly used but under-evaluated interventions. There is also a need to alert SLTs to the evidence base supporting other approaches, particularly switch-based, cause and effect approaches.