Microswitch Clusters Promote Adaptive Responses and Reduce Finger Mouthing in a Boy With Multiple Disabilities

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.

Microswitch Technology to Promote Adaptive Responses and Reduce Mouthing in Two Children with Multiple Disabilities

This study assessed the viability of using microswitch clusters (combinations of microswitches) plus contingent stimulation to promote adaptive responding and to reduce aberrant behavior in two children with multiple disabilities. The results revealed that both children increased their adaptive responses, learned to perform these responses free from aberrant behavior, and maintained this level of performance three months later.

Persons with multiple disabilities increase adaptive responding and control inadequate posture or behavior through programs based on microswitch-cluster technology

Study I used typical microswitch-cluster programs to promote adaptive responding (i.e., object manipulation) and reduce inappropriate head or head-trunk forward leaning with a boy and a woman with multiple disabilities. Optic, tilt, and vibration microswitches were used to record their adaptive responses while optic and tilt microswitches monitored their posture. The study included an ABB(1)AB(1) sequence, in which A represented baseline phases, B represented an intervention phase in which adaptive responses were always followed by preferred stimulation, and B(1) represented intervention phases in which the adaptive responses led to preferred stimulation only if the inappropriate posture was absent. Study II assessed a non-typical, new microswitch-cluster program to promote two adaptive responses (i.e., mouth cleaning to reduce drooling effects and object assembling) with a man with multiple disabilities. Initially, the man received preferred stimulation for each cleaning response. Then, he received stimulation only if mouth cleaning was preceded by object assembling. The results of Study I showed that both participants had large increases in adaptive responding and a drastic reduction in inappropriate posture during the B(1) phases and a 2-week post-intervention check. The results of Study II showed that the man learned to control drooling effects through mouth cleaning and used object assembling to extend constructive engagement and interspace cleaning responses functionally. The practical implications of the findings are discussed.

Self-injurious behavior in people with profound intellectual disabilities: a meta-analysis of single-case studies

The limitations people with profound intellectual disabilities experience in functioning contribute to a vulnerability to self-injurious behavior. Since this problem behavior has important negative consequences for people concerned, examining the effectiveness of treatments is important. In the current meta-analysis, single-case studies investigating non-aversive, non-intrusive forms of reinforcement were combined using hierarchical linear models. This analysis revealed that the average effect of treatment was relatively large and statistically significant. Further, significant variance was observed between both studies and participants. In addition, some evidence was found for a moderator effect of sensory impairment. Finally, no statistically significant moderator effects of medication, motor impairment, setting, age, gender, matching of treatment with behavioral function and contingency were found.

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.

Helping a man with multiple disabilities increase object-contact responses and reduce hand stereotypy via a microswitch cluster program

BACKGROUND

People with profound and multiple disabilities often display aberrant behaviours (such as stereotypical movements) which can inhibit learning and lead to social stigmatisation. This study was designed to help a man with multiple disabilities increase his object-contact responses and reduce hand stereotypy (in this case, hand/wrist rotation).

METHOD

An A-B-A-B design with a 3-month post-intervention check was employed. At baseline, a combination of microswitches (or microswitch cluster) was used to monitor the man's object-contact responses and hand stereotypy. During the intervention phases and post-intervention check, the microswitch cluster was combined with preferred stimuli for object-contact responses occurring without hand stereotypy. The stimulation lasted for 8 seconds if the man remained free from hand stereotypy for that time, but was interrupted if the stereotypy appeared.

RESULTS

The intervention showed an increase in object-contact responses occurring without hand stereotypy and a reduction in session time with hand stereotypy. These data were maintained at the 3-month post-intervention check.

CONCLUSION

Replication of these findings with other individuals would confirm the utility of this type of intervention for increasing constructive responding and reducing stereotyped behaviours.

A Girl With Multiple Disabilities Increases Object Manipulation and Reduces Hand Mouthing Through a Microswitch-Based Program

The study was an effort to help a girl with multiple disabilities increase object manipulation responses and reduce hand mouthing, carried out according to an ABAB sequence (in which A represented baseline phases; B, treatment phases) and including a 3-month follow-up. During the baseline phases, a microswitch cluster (i.e., a combination of microswitches) was used to monitor the girl's object manipulation responses and hand mouthing. Indices of happiness were also recorded. During the treatment phases and follow-up, the microswitch cluster was combined with the use of preferred stimuli for object manipulation responses. The stimuli lasted an 8-s period at each response if the girl remained free from hand mouthing through that period, but were interrupted if hand mouthing appeared. The results show that the girl increased object manipulation responses, learned to refrain from hand mouthing for most of the session time, maintained this performance over time, and showed an increase in indices of happiness.

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.

Promoting Adaptive Foot Movements and Reducing Hand Mouthing and Eye Poking in a Boy with Multiple Disabilities through Microswitch Technology

This study assessed the viability of a microswitch cluster (i.e. a combination of microswitches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behavior in a boy with profound multiple disabilities. The boy was initially taught an adaptive foot-movement response that activated a motion microswitch and produced preferred stimuli. Subsequently, his foot response led to preferred stimuli only if it occurred in the absence of aberrant behavior (i.e. hand mouthing and eye poking which were detected through optic microswitches). Moreover, full access to the stimuli required that the boy refrain from aberrant behavior during their presentation as well. The study also included a 3-month post-intervention check and a social validation assessment. Data showed that the boy (i) increased his adaptive responding, (ii) learned to perform this responding largely free from aberrant behavior and refrained from that behavior for most of the session time, and (iii) maintained this performance at the post-intervention check. The social validation ratings of 40 teachers and teacher assistants significantly favored the last intervention period (in which aberrant behavior was reduced) over the initial period.