Experimental Examination and Social Validation of a Microswitch Intervention to Improve Choice-Making and Activity Engagement for Six Girls with Rett Syndrome

Background: The use of assistive technology, specifically microswitches, with children with RTT has been shown to effectively moderate the impact of their disability on their quality of life^- by facilitating access to meaningful leisure and other activities. Objectives: This study aimed to evaluate the effectiveness of a microswitch intervention on increased choice making, engagement in a targeted sorting activity, and indices of happiness, and decreased stereotypic behaviors for six girls with Rett syndrome. Targeted dependent variables were also assessed at six months post-intervention. Following the intervention study, 90 external raters completed a social validation procedure. Method: An ABABAB experimental sequence was implemented for each participant with a cross-over effect. A social validation assessment involving 90 external raters was carried out. Results: Data emphasized an improved performance for each participants involved (i.e., adaptive responses). Five participants showed a capacity of independent choice. One participant seemed to be closely linked to the position of the container. Social raters favorably endorsed the use of the program since they positively evaluated the use of the technology on all the dimensions investigated. Conclusion: A microswitch intervention may improve choice making and activity engagement for children with Rett syndrome. Further research is needed on the development of more sophisticated forms of individualized technological options to improve opportunities for enhanced engagement and choice-making for individuals with RTT.

Assistive technology for persons with profound intellectual disability: a european survey on attitudes and beliefs

BACKGROUND

Persons with profound intellectual disability (PID) are mostly not able to use assistive technology (AT) independently. Caregivers play an important mediating role in implementing AT in the daily life of persons with PID. Both first-order barriers, extrinsic to caregivers, and second-order barriers, intrinsic to caregivers, influence the attitudes and behaviors of caregivers with regard to AT-use. It could be asked if increased knowledge on and experience with AT may impact the effect of first- and second-order barriers. This study investigated how knowledge and experience influence the professional caregivers' beliefs about which factors may impact the AT use in persons with PID and their intentions to use AT for persons with PID.

METHODS

A questionnaire on the experienced limitations and successes in using AT was developed. The questionnaire was send to professionals working with or responsible for persons with PID in various countries in Europe. In total the answers of 195 respondents were included in this study.

RESULTS AND CONCLUSIONS

This study's results demonstrate that AT is used for various reasons in persons with PID, mostly to support communication and interaction or for fun or relaxation. Based on the answers of the respondents can be concluded that both experience and knowledge of caregivers seem to influence first- and second-order barriers. Besides, a possibility to overcome the second-order barriers is to provide professionals with possibilities to increase their knowledge and experience.IMPLICATIONS FOR REHABILITATIONAT for persons with PID is mostly used for communication and interaction or for fun and relaxation.Professional caregivers belief that AT-use may positively influence various aspects in the life of persons with PID, especially communication and interaction, active engagement and participation in activities, and self-esteem of the person.Caregivers need to have sufficient experience in order to rate the barriers of AT-use as less limited in the group of persons with PID.In order to overcome the barriers experienced in implementing AT in persons with PID, knowledge of caregivers is essential.

Case Studies of Technology-aided Interventions to Promote Hand Reaching and Standing or Basic Ambulation in Persons with Multiple Disabilities

Motor impairments such as lack of standing and/or independent ambulation are common among persons with multiple disabilities. These two studies assessed technology-aided programs for persons with those impairments. Specifically, Study I assessed a program to teach two non-ambulatory adults to hand reach a stimulation-linked object by standing up. Study II assessed a program to teach a child and a man to ambulate while holding a rail or following a corridor wall. Standing increased from below 15% to about or over 80% of the session duration in Study I. The participants of Study II managed to complete brief ambulation trials independent of guidance. These performance achievements were discussed in relation to the technology-aided programs employed in the studies and the programs' applicability in daily contexts.

New camera-based microswitch technology to monitor small head and mouth responses of children with multiple disabilities

OBJECTIVE

Assessing a new camera-based microswitch technology, which did not require the use of color marks on the participants' face.

METHOD

Two children with extensive multiple disabilities participated. The responses selected for them consisted of small, lateral head movements and mouth closing or opening. The intervention was carried out according to a multiple probe design across responses. The technology involved a computer with a CPU using a 2-GHz clock, a USB video camera with a 16-mm lens, a USB cable connecting the camera and the computer, and a special software program written in ISO C++ language.

RESULTS

The new technology was satisfactorily used with both children. Large increases in their responding were observed during the intervention periods (i.e. when the responses were followed by preferred stimulation).

CONCLUSION

The new technology may be an important resource for persons with multiple disabilities and minimal motor behavior.

Further evaluation of a telephone technology for enabling persons with multiple disabilities and lack of speech to make phone contacts with socially relevant partners

This study assessed whether a girl and a woman with multiple disabilities could (a) make phone contacts with relevant partners through a special telephone technology, and (b) enjoy their telephone-mediated communication with them. The technology involved a net-book computer, a global system for mobile communication modem (GSM), an optic microswitch, and specific software. The technology was programmed to present the names of the partners available for contact, and the participants could choose at each presentation sequence the one they wanted to contact with a simple microswitch response. Such response triggered the computer to place a phone call to that partner. Both participants (a) learned to use the technology quite rapidly to contact relevant partners and maintained the successful use of it over the intervention and post-intervention sessions, (b) showed high levels of indices of happiness during the phone calls as opposed to pre-baseline control sessions, and (c) showed preferences among the partners. Implications of the findings are discussed.

Technology-aided programs to enable persons with multiple disabilities to choose among environmental stimuli using a smile or a tongue response

Persons with multiple disabilities, including pervasive motor impairment, may have problems controlling even small responses (e.g., vocal emissions, finger movements, or prolonged eyelid closures) within time-sensitive situations, such as those involved in choice programs. Recent research has indicated that smile expressions can be used as functional choice responses for some of these persons. The present two studies were aimed at assessing the smile response for a child with congenital multiple disabilities and a tongue response for a post-coma man who had recovered his consciousness but presented with pervasive multiple disabilities. The first of the two studies represented a research extension (i.e., a new case with a slightly adapted microswitch technology) concerning the smile response, which had recently been evaluated with few other cases. The second study represented a new effort to assess the tongue response within a choice program and for a post-coma man with multiple disabilities. The results showed that the participants used the smile and the tongue responses successfully while they were apparently unsuccessful in using a slight head/chin movement response. Their choice behavior focused reliably on preferred stimuli and avoided non-preferred stimuli. Implications of the results are discussed.

Three non-ambulatory adults with multiple disabilities exercise foot-leg movements through microswitch-aided programs

This study assessed the use of microswitch-aided programs to help three non-ambulatory adults with multiple disabilities exercise foot-leg responses. Those responses served to activate a largely neglected part of the participants' body, with possibly positive physical implications (e.g., for blood circulation, swelling, and muscle strength). Intervention focused on the left and right foot-leg response, separately. Eventually, sessions with one response were alternated with sessions with the other response. Responses were monitored via microswitches and followed by 8s of preferred stimulation (e.g., music and vibrotactile stimulation), which was automatically delivered. The results showed that all three participants had high levels of foot-leg responses during the intervention phases and a 3-week post-intervention check. The participants also displayed expressions of positive involvement during those study periods (i.e., engaged in behaviors, such as music-related head movements, smiles, or touching the vibratory devices) that could be interpreted as forms of interest/pleasure and happiness. These results are in line with previous findings in this area and can be taken as an important confirmation of the strength and dependability of the approach in motivating non-ambulatory persons with multiple disabilities to engage in foot-leg movements. The practical implications of these findings are discussed.

Technology-aided programs to support exercise of adaptive head responses or leg-foot and hands responses in children with multiple disabilities

OBJECTIVE

Assessing the effectiveness of technology-aided programs to help three children with multiple disabilities exercise adaptive head or leg-foot and hands responses independently.

METHOD

The response selected for the two children included in Study I was head rotation (i.e. movements of at least 25 degrees to the left that could start from a full right position as well as from other positions). The responses selected for the child included in Study II involved forward movement of the left leg-foot and forward movement of his hand(s) to touch objects. Tilt or optic microswitches were used to monitor the responses and a computer system regulated the stimuli contingent on them.

RESULTS

The responses targeted in the two studies showed large frequency increases during the intervention phases of the studies (i.e. when followed by stimulation).

CONCLUSION

Technology-aided programs can be a useful resource to help children with multiple disabilities exercise relevant responses independently.

Self-regulated music stimulation for persons with Alzheimer's disease: impact assessment and social validation

OBJECTIVE

To assess the impact and the social rating of an active music condition (in which 10 patients with Alzheimer's disease regulated their music input) vs. a passive music condition.

METHOD

In the active condition, the patients used a simple hand response and a microswitch to activate music stimulation periods. In the passive condition, music stimulation was prearranged and continued through the sessions. The active and passive stimulation sessions were preceded and followed by control (non-stimulation) sessions.

RESULTS

The active condition sessions showed an increase in the patients' indices of positive participation (e.g., singing or music-related movements, and smiles) similar to that observed in the passive condition sessions. Social raters (140 psychology students) favored the active condition on a six-item questionnaire dealing, among others, with conditions' suitability, respect of patients' dignity and independence, and practicality.

CONCLUSION

An active music stimulation condition can be viable, effective, and socially preferable.

Persons with multiple disabilities use forehead and smile responses to access or choose among technology-aided stimulation events

A variety of technology-aided programs have been developed to help persons with congenital or acquired multiple disabilities access preferred stimuli or choose among stimulus options. The application of those programs may pose problems when the participants have very limited behavior repertoires and are unable to use conventional responses and microswitches. The present two studies assessed non-conventional response-microswitch solutions for three of those participants. Study I included two participants who were exposed to a program in which forehead skin movement was the response required to access preferred stimulation. The microswitch was an optic sensor combined with a small black sticker on the forehead. Study II included one participant who was exposed to a program in which a smile response was required to choose among stimuli. The microswitch for monitoring the smile was a new camera-based technology. The results of the two studies showed that the response-microswitch solutions were suitable for the participants and enabled them to perform successfully. Implications of the studies for people with limited motor behavior and issues for future research were discussed.

Challenges of developing communicative interaction in individuals with congenital profound intellectual and multiple disabilities

BACKGROUND

Physiological responses have been used in individuals with acquired disability to enable communicative interaction without motor movement. This study explored four autonomic nervous system (ANS) signals-electrodermal activity, skin temperature, cardiac patterns and respiratory patterns-to enable interaction with individuals born with profound intellectual and multiple disabilities (PIMD).

METHOD

A series of case studies were conducted to teach a 15-year-old individual with PIMD to voluntarily control his ANS signals for the purposes of communicative interaction. Training was carried out according to an alternating treatment single-subject research design.

RESULTS

Training was unsuccessful; however, ANS signal patterns revealed issues unique to people with PIMD: profound intrasubject variability, discrepancy between physiological responses and caregiver perspectives, and the participant's lack of contingency awareness.

CONCLUSIONS

These three priority areas unique to people with congenital PIMD must be addressed before ANS signals can be used to enable communicative interaction with this population.

Two persons with multiple disabilities use camera-based microswitch technology to control stimulation with small mouth and eyelid responses

BACKGROUND

A camera-based microswitch technology was recently developed to monitor small facial responses of persons with multiple disabilities and allow those responses to control environmental stimulation. This study assessed such a technology with 2 new participants using slight variations of previous responses.

METHOD

The technology involved a computer with a CPU using a 2GHz clock, a USB video camera with 16-mm lens, and special software. Small colour spots were used under the lower lip of one participant and on the eyelid of the other participant to aid the camera and computer to detect their mouth and eyelid responses. The study involved an ABAB design and included a 3-week post-intervention check.

RESULTS

The participants' mouth and eyelid responses increased during the intervention (B) phases and post-intervention check (i.e., when the technology allowed them to control stimulation).

CONCLUSIONS

Camera-based microswitch technology can help persons with multiple disabilities control stimulation with small responses.

Access to environmental stimulation via eyelid responses for persons with acquired brain injury and multiple disabilities: a new microswitch arrangement

This study assessed a new microswitch arrangement for eyelid responses using an optic sensor placed above the cheekbone and a small sticker on the person's eyelid. This new arrangement, which was designed to avoid interference of the microswitch with the person's visual functioning, was tested on three adults with acquired brain injury and multiple (consciousness, communication, and motor) disabilities. The study was carried out according to a non-concurrent multiple baseline design across participants. Data showed the new microswitch arrangement was suitable for all three participants, who increased their responding during the intervention phase of the study when their responses allowed them to access preferred stimulation. Practical implications of the findings are discussed.

Persons with multiple disabilities exercise adaptive response schemes with the help of technology-based programs: three single-case studies

The present three single-case studies assessed the effectiveness of technology-based programs to help three persons with multiple disabilities exercise adaptive response schemes independently. The response schemes included (a) left and right head movements for a man who kept his head increasingly static on his wheelchair's headrest (Study I), (b) left- and right-arm movements for a woman who tended to hold both arms/hands tight against her body (Study II), and (c) touching object cues on a computer screen for a girl who rarely used her residual vision for orienting/guiding her hand responses. The technology involved microswitches/sensors to detect the response schemes and a computer/control system to record their occurrences and activate preferred stimuli contingent on them. Results showed large increases in the response schemes targeted for each of the three participants during the intervention phases of the studies. The importance of using technology-based programs as tools for enabling persons with profound and multiple disabilities to practice relevant responses independently was discussed.

Post-coma persons emerged from a minimally conscious state and showing multiple disabilities learn to manage a radio-listening activity

This study assessed microswitch-based technology to enable three post-coma adults, who had emerged from a minimally conscious state but presented motor and communication disabilities, to operate a radio device. The material involved a modified radio device, a microprocessor-based electronic control unit, a personal microswitch, and an amplified MP3 player. The study was carried out according to a non-concurrent multiple baseline design across participants. During the intervention, all three participants learned to operate the radio device, changing stations and tuning on some of them longer amounts of time than on others (i.e., suggesting preferences among the topics covered by those stations). They also ended a number of sessions before the maximum length of time allowed for them had elapsed. The practical (rehabilitation) implications of the findings were discussed.

Persons with multiple disabilities select environmental stimuli through a smile response monitored via camera-based technology

OBJECTIVE

To assess whether two persons with multiple disabilities could use smile expressions and new camera-based microswitch technology to select environmental stimuli.

METHOD

Within each session, a computer system provided samples/reminders of preferred and non-preferred stimuli. The camera-based microswitch determined whether the participants had smile expressions in relation to those samples. If they did, stimuli matching the specific samples to which they responded were presented for 20 seconds.

RESULTS

The smile expression could be profitably used by the participants who managed to select means of ∼70% or 75% of the preferred stimulus opportunities made available by the environment while avoiding almost all the non-preferred stimulus opportunities.

CONCLUSION

Smile expressions (a) might be an effective and rapid means for selecting preferred stimulation and (b) might develop into cognitively more elaborate forms of responding through the learning experience (i.e. their consistent association with positive/reinforcing consequences).

A technology-aided stimulus choice program for two adults with multiple disabilities: choice responses and mood

This study was aimed at replicating and extending early research on technology-aided stimulus choice with two adults with multiple disabilities. The technology-aided program involved (a) a computer-aided system presenting the participants samples of different environmental stimuli and (b) a microswitch device allowing them to choose among those samples and to access the related stimuli for preset periods of time. The system also allowed the participants opportunities to request the continuation/repetition of any stimulus. The program was successful in promoting the participants' selection of preferred stimuli and their requests for continuation/repetition of those stimuli. Data also showed that the intervention sessions largely improved the participants' mood (i.e., increased their indices of happiness). Theoretical and practical relevance of the findings were discussed.

Microswitch-cluster technology to enhance adaptive engagement and head upright by a post-coma man with multiple disabilities

OBJECTIVE

To evaluate microswitch-cluster technology to help a post-coma man with multiple disabilities increase adaptive responding and reduce head forward tilting.

METHOD

The intervention programme initially focused on promoting a simple adaptive response (i.e. manipulating and moving a wobbling, ball-like device), which produced brief periods of preferred stimulation. Subsequently, this response produced the stimulation only if performed in the presence of head upright. Moreover, the stimulation lasted the scheduled time only if the head upright was maintained.

RESULTS

Data showed that the programme was successful in increasing the frequency of adaptive responses and in reducing the unhealthy posture of head forward tilting. Toward the end of the programme, the participant performed virtually all responses with his head upright and kept this posture through nearly the entire length of the sessions.

CONCLUSION

Microswitch-cluster technology might help post-coma persons with multiple disabilities improve adaptive engagement and head posture simultaneously.

Adapting a computer-assisted program to help a post-coma man with extensive multiple disabilities choose stimulus events

OBJECTIVE

To adapt an existing computer-assisted program to help a post-coma man with extensive multiple disabilities choose between stimulus events.

METHOD

An adapted version of the program assessed in this study presented the man with 7-second samples of preferred and non-preferred stimuli, without questions, and allowed him to choose any of them through a vocalization response. The man's use of this response to choose a stimulus sample led the computer to present the matching stimulus for 20 seconds. The same response used immediately after the end of the 20-second stimulus presentation led to the repetition of that presentation.

RESULTS

The adapted program version was effective in promoting high levels of choice among preferred stimuli and virtually no responding in relation to non-preferred stimuli. Indices of happiness were frequent during the program sessions.

CONCLUSIONS

Computer-assisted programs for stimulus choice might be successfully adapted to post-coma persons with extensive disabilities.

Microswitch and keyboard-emulator technology to facilitate the writing performance of persons with extensive motor disabilities

This study assessed the effectiveness of microswitches for simple responses (i.e., partial hand closure, vocalization, and hand stroking) and a keyboard emulator to facilitate the writing performance of three participants with extensive motor disabilities. The study was carried out according to an ABAB design. During the A phases, the participants (one child and two adults) were to write using the responses and technology available to them prior to this study. During the B phases, they used the new responses and technology. Data showed that two of the three participants had a faster writing performance during the B phases while the third participant had a slower writing performance. All three participants indicated a clear preference for the use of the new responses and technology, which were considered relatively easy and comfortable to manage and did not seem to cause any specific signs of tiredness. Implications of the findings are discussed.

Camera-based microswitch technology for eyelid and mouth responses of persons with profound multiple disabilities: two case studies

These two studies assessed camera-based microswitch technology for eyelid and mouth responses of two persons with profound multiple disabilities and minimal motor behavior. This technology, in contrast with the traditional optic microswitches used for those responses, did not require support frames on the participants' face but only small color marks. The person involved in Study I had previously used optic sensors fixed on an eyeglasses' frame for detecting his eyelid- and mouth-opening responses. However, a deterioration of his head posture was making the correct location/use of this frame progressively more difficult. The person involved in Study II had previously been selected for a program relying on eyelid-closure responses and an optic sensor. Such a program however appeared difficult to implement given his sideward lying position and dystonic head movements. The new technology could be satisfactorily applied with both participants using mouth and eyelid opening with the first participant and eyelid closures with the second participant. Both participants had large increases in responding during the intervention periods (i.e., when their responses were followed by preferred stimulation). The findings are discussed in relation to the role of the new technology in helping persons with multiple disabilities and minimal motor behavior.

Use of microswitch technology and a keyboard emulator to support literacy performance of persons with extensive neuro-motor disabilities

OBJECTIVE

To assess the effectiveness and acceptability of microswitch technology and a keyboard emulator to enable three participants with extensive neuro-motor disabilities to write words.

METHOD

In Study I, two participants triggered an automatic scanning keyboard and selected/wrote letters via a small sliding movement of their hand(s) activating a touch/pressure panel (microswitch). In Study II, a third participant used the sliding movement and panel and a vocalization response with a voice-detecting microswitch. The sliding movement allowed her to light up the keyboard and select the letters and the vocalization to perform the scanning.

RESULTS

Participants showed a better performance (shorter writing time) or an equally effective but less tiring performance with the new microswitch technology and response(s). They also preferred using this technology, and social validation ratings favoured such technology over previous solutions.

CONCLUSION

The aforementioned technology may be useful to enable persons with extensive neuro-motor disabilities to write successfully.

Persons with Acquired Brain Injury and Multiple Disabilities Access Stimulation Independently through Microswitch-Based Technology

The possibility of enabling two adults with acquired brain injury and profound multiple disabilities to use microswitch-based technology to attain preferred environmental stimuli on their own was assessed. Each of the participants was provided with two microswitches that could be activated by right and left head-turning or head-bending responses. The microswitches were introduced sequentially according to a multiple probe design across microswitches (responses) and allowed access to different sets of auditory or visual stimuli. Eventually, the two microswitches were made available simultaneously. Sessions lasted 5 min. Each participant learned to use the two microswitches successfully and maintained consistent levels of responding when they were simultaneously available. During this phase, both participants showed large within-session variations in their right and left response frequencies, with one of them showing an overall prevalence of the left-side response. The importance of assistive technology within programs for persons with acquired brain injury and multiple disabilities is discussed.

Automatic Prompting and Positive Attention to Reduce Tongue Protrusion and Head Tilting by Two Adults With Severe to Profound Intellectual Disabilities

This study assessed a simple behavioral strategy for reducing stereotypic tongue protrusion and forward head tilting displayed by a woman and a man with severe to profound intellectual disabilities. The strategy involved (a) auditory prompting (i.e., verbal encouragements to keep the tongue in the mouth or the head upright) delivered automatically at fixed intervals via a portable device, and (b) social approval delivered by a research assistant at adjustable intervals for the absence of the inappropriate behavior. The intervals arranged for the delivery of approval were extended if the inappropriate behavior occurred in concomitance with the expected delivery. Data showed that the intervention strategy was effective in reducing the stereotypic tongue protrusion and forward head tilting. Their occurrences dropped from above 40% (tongue protrusion) and close to 80% (head tilting) of the observation instances during the initial baseline to around or slightly above 10% of those instances during the second intervention period and the 3-month postintervention check.

A microswitch to enable a woman with acquired brain injury and profound multiple disabilities to access environmental stimulation with lip movements

This study assessed a new type of microswitch designed to enable a woman with acquired brain injury and profound multiple disabilities to access environmental stimulation through lip movements. The microswitch involved two optic sensors aimed at detecting changes in lip positions. Data showed that the microswitch was suitable and functional for the participant who increased her responding (lip movements) during the intervention phases of the study, that is, when her responses allowed her to access preferred stimulation. Practical implications of the findings were discussed.

Helping a man with multiple disabilities to use single vs repeated performance of simple motor schemes as different responses

A man with multiple disabilities was taught to use single vs repeated performance of simple motor schemes as different responses. Specifically, single and double emissions of a finger movement served as two separate responses, which allowed direct access to different environmental stimuli via microswitch technology. Single and double emissions of a head movement served as two additional responses, which allowed interaction with two different caregivers who were called via voice output communication aids (VOCAs). The results showed that the man, who had pervasive motor impairment, acquired the four responses available and seemed to use them purposefully. The implications of this approach to increase the response options of persons with few controllable motor schemes were discussed.

A technology-based stimulation program to reduce hand mouthing by an adolescent with multiple disabilities

This study assessed the possibility of reducing hand mouthing, i.e., bringing fingers into or over the mouth, by an adolescent with multiple disabilities through a technology-based stimulation strategy. The strategy ensured that (a) the participant received 10 sec. of preferred stimulation contingent on the response of bringing both hands into a box with objects, and (b) the stimulation would be interrupted prematurely if the participant removed one or both hands from the box for 2 sec. The study involved an ABAB sequence (in which A represented baseline and B intervention phases) and a 3-mo. postintervention check. Data showed that the response of bringing both hands into the box increased from a mean frequency of about four per 10-min. session during baseline to a mean frequency of over 30 per session during the second intervention phase and the postintervention check. During these periods, the participant's mean hand-mouthing time per session was below 1.5 min. (compared to above 7 min. during baseline) and the mean stimulation time per session was about 4 min. Practical implications of the findings are discussed.

Microswitch- and VOCA-assisted programs for two post-coma persons with minimally conscious state and pervasive motor disabilities

Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with minimally conscious state and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music intervals, and (b) a voice output communication aid (VOCA) with two channels, activated via different hand-closure movements, which allowed the man to call his mother and a research assistant who provided stimulation events. Study II assessed a program that included (a) a pressure microswitch, activated via head movements, which allowed a man direct access to video-clips and music, and (b) a VOCA device, activated via prolonged eyelid closure, which allowed the man to call the caregiver (i.e., a research assistant) who provided attention and sung to him. Each of the two participants had significant increases in both microswitch- and VOCA-related responses during the intervention phases of the studies. Moreover, purposeful choice seemed to occur between the two VOCA responses in Study I. Implications of the findings for improving the situation of post-coma persons with minimally conscious state and pervasive motor disabilities are discussed.

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.

Technology-based intervention options for post-coma persons with minimally conscious state and pervasive motor disabilities

BACKGROUND

Intervention strategies, based on learning principles and assistive technology, were assessed with four post-coma persons with minimally conscious state and pervasive motor disabilities.

METHOD

The first study taught a man to access environmental stimulation through a response-microswitch combination and another man to access environmental stimulation and request social contact through responses combined with a microswitch or a Voice Output Communication Aid (VOCA). The second study taught a man to access two forms of environmental stimulation via two response-microswitch combinations and another man to request two forms of contact via two response-VOCA combinations.

RESULTS

Data showed that all participants had significant increases in response levels (independent of whether the responses were combined with microswitch or VOCA devices) during the intervention phases of the studies.

CONCLUSION

Intervention strategies based on learning principles and technology may be largely helpful for persons with minimally conscious state and pervasive motor disabilities.

Microswitch for vocalization responses: comparing single- versus dual-microphone arrangements for a man with multiple disabilities

Microswitches are technical devices designed to enable persons with multiple disabilities to control environmental events, generally preferred stimuli such as music and lights, using simple/feasible responses. For example, a sound-detecting microswitch may allow a person to turn on brief periods of preferred stimulation through simple vocal responses. This study compared the accuracy of two versions of a sound-detecting microswitch, i.e., one using a throat microphone and the other both throat and airborne microphones, for a man with multiple disabilities. Analysis showed that the latter microswitch version radically reduced the false activations present with the former microswitch version. Thus, the latter version seemed to have a clear accuracy advantage over the former with important practical implications.