Teaching students with developmental disabilities to operate an iPod Touch(®) to listen to music

We evaluated an intervention procedure for teaching three students with developmental disabilities to independently operate a portable multimedia device (i.e., an iPod Touch(®)) to listen to music. The intervention procedure included the use of video modeling, which was presented on the same iPod Touch(®) that the students were taught to operate to listen to music. Four phases (i.e., baseline, intervention, fading, and follow-up) were arranged in accordance with a delayed multiple-probe across participants design. During baseline, the students performed from 25 to 62.5% of the task analyzed steps correctly. With intervention, all three students correctly performed 80-100% of the steps and maintained this level of performance when video modeling was removed and during follow-up. The findings suggest that the video modeling procedure was effective for teaching the students to independently operate a portable multimedia device to access age-appropriate leisure content.

A verbal-instruction system to help persons with multiple disabilities perform complex food- and drink-preparation tasks independently

In a recent single-case study, we showed that a new verbal-instruction system, ensuring the automatic presentation of step instructions, was beneficial for promoting the task performance of a woman with multiple disabilities (including blindness). The present study was aimed at replicating and extending the aforementioned investigation with three adults with multiple disabilities. During Part I of the study, the new instruction system was compared with a system requiring the participants to seek instructions on their own. Two tasks were used, one per system. During Part II of the study, the new system was applied with two additional tasks. The results of Part I showed that (a) the participants had a better performance (i.e., in terms of correct steps or task execution time) on the task carried out with the new system than on the task carried out with the comparison/control system, and (b) the performance of this latter task improved rapidly when the new system was used with it. The results of Part II showed satisfactory performance with each of the two tasks carried out directly with the new system. The implications of these data were discussed.

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.

Two adults with multiple disabilities use a computer-aided telephone system to make phone calls independently

This study extended the assessment of a newly developed computer-aided telephone system with two participants (adults) who presented with blindness or severe visual impairment and motor or motor and intellectual disabilities. For each participant, the study was carried out according to an ABAB design, in which the A represented baseline phases and the B represented intervention phases, during which the special telephone system was available. The system involved among others a net-book computer provided with specific software, a global system for mobile communication modem, and a microswitch. Both participants learned to use the system very rapidly and managed to make phone calls independently to a variety of partners such as family members, friends and staff personnel. The results were discussed in terms of the technology under investigation (its advantages, drawbacks, and need of improvement) and the social-communication impact it can make for persons with multiple disabilities.

Promoting mouth drying to reduce the effects of drooling in a woman with multiple disabilities: a new evaluation of microswitch-programme conditions

OBJECTIVE

Extending the use of microswitch-based programmes to (a) establish mouth-drying responses and reduce the effects of drooling, (b) assess the possibility of widening inter-response intervals and (c) determine whether different microswitch solutions would impact the accuracy/effectiveness of mouth drying.

METHOD

During the intervention phases of the study, the participant (woman) performed mouth-drying responses via a special napkin. Such napkin contained two pressure sensors/microswitches, a microprocessor and an MP3 serving to monitor responses and ensure stimulation contingent on them.

RESULTS

The participant (a) learned to dry her mouth and reduce her chin wetness, (b) stabilized her responding at lower frequencies (i.e. when the stimulation period was extended) and (c) produced more accurate/effective responses when she was required to trigger both sensors of the napkin.

CONCLUSION

Microswitch-based programmes may promote practically sustainable and effective mouth drying to reduce drooling effects in persons with multiple disabilities.

Persons with mild or moderate Alzheimer's disease use a basic orientation technology to travel to different rooms within a day center

This study assessed whether three patients with Alzheimer's disease could learn to use a basic orientation technology to reach different rooms within a day center. At each travel instance, the technology provided verbal messages (cues) from the room to reach. For the first two patients, the messages were presented at intervals of about 15s. For the third patient (who had more extensive orientation problems), shorter intervals combined with the voice of the research assistant were initially used. Results showed that all three patients were successful in using the technology to orient their travel and find the rooms correctly. A social validation assessment, in which university psychology students were asked to rate the patients' travel performance with the technology and with the help of a caregiver, provided generally higher (more positive) scores for the technology-assisted performance. The implications of the findings for daily programs of patients with Alzheimer's disease are discussed.

Post-coma persons with extensive multiple disabilities use microswitch technology to access selected stimulus events or operate a radio device

The present two studies extended research evidence on the use of microswitch technology by post-coma persons with multiple disabilities. Specifically, Study I examined whether three adults with a diagnosis of minimally conscious state and multiple disabilities could use microswitches as tools to access brief, selected stimulus events. Study II assessed whether an adult, who had emerged from a minimally conscious state but was affected by multiple disabilities, could manage the use of a radio device via a microswitch-aided program. Results showed that the participants of Study I had a significant increase of microswitch responding during the intervention phases. The participant of Study II learned to change radio stations and seemed to spend different amounts of session time on the different stations available (suggesting preferences among the programs characterizing them). The importance of microswitch technology for assisting post-coma persons with multiple disabilities to positively engage with their environment was discussed.

Assessing preferences for AAC options in communication interventions for individuals with developmental disabilities: a review of the literature

We synthesized studies that assessed preference for using different augmentative and alternative communication (AAC) options. Studies were identified via systematic searches of electronic databases, journals, and reference lists. Studies were evaluated in terms of: (a) participants, (b) setting, (c) communication options assessed, (d) design, (e) communication skill(s) taught to the participant, (f) intervention procedures, (g) outcomes of the intervention and outcome of the preference assessment, (h) follow-up and generalization, and (i) reliability of data collection and treatment integrity. Seven studies, involving 12 participants, met the inclusion criteria. In these studies, individuals were taught to use either speech-generating devices (SGD), (b) picture exchange (PE) systems, and/or (c) manual signs. Assessments to identify preferences for using each AAC option were conducted in each study. Sixty-seven percent (n=8) of participants demonstrated some degree (≥55%) of preference for using SGD compared to 33% (n=4) of participants who demonstrated some degree (≥55%) of preference for PE. The results indicate that individuals with developmental disabilities often show a preference for different AAC options. Incorporating an assessment of such preferences might therefore enable individuals to exert some degree of self-determination with respect to AAC intervention.

Persons with mild or moderate Alzheimer's disease learn to use urine alarms and prompts to avoid large urinary accidents

This study assessed whether three patients with Alzheimer's disease could learn to use urine alarms and caregivers' prompts to eliminate large urinary accidents. As soon as the patient began to release urine, the alarm system presented auditory and vibratory signals. In relation to those signals, the caregiver would prompt/encourage the patient to stop urinating and accompany him or her to the toilet to void. After urination, the caregiver provided the patient positive social attention. The results of the intervention showed that the use of the alarm system and caregivers' prompts was effective in helping the three patients reduce their large urinary accidents to zero or near zero levels. Self-initiated toileting, which was minimal during baseline, accounted for nearly 35%, 50% and 75% of the patients' toileting occasions during the intervention. Fifty-two caregivers, who participated in a social validation assessment of toileting approaches relying on alarm systems or timed toileting, seemed to find the former preferable for the patients, for the context, as well as for themselves. The implications of the findings for daily programs of patients with Alzheimer's disease and other dementias are discussed.

Communication opportunities via special messaging technology for two post-coma persons with multiple disabilities

This study extended the assessment of a special messaging technology with two additional post-coma adults who had emerged from a minimally conscious state, but showed multiple disabilities including profound motor and communication impairments. For each participant, the study involved an ABAB design, in which the A represented baseline phases and the B represented intervention phases with the special messaging technology. The technology involved a net-book computer provided with specific software, a global system for mobile communication (GSM) modem, microswitches, and prerecorded verbal lists of persons' names and messages. Both participants learned to send out and receive (listen to) messages independently during the intervention, thus providing clear support for previous data in the area. They sent out means of about three and 17 messages and received means of about two and six messages per 20- and 30-min session, respectively. The positive impact of the technology was discussed in relation to previous data in this area and the possibility of helping post-coma persons with multiple disabilities engage in basic communication with distant partners.

Technology-assisted writing opportunities for a man emerged from a minimally conscious state and affected by extensive motor disabilities

OBJECTIVE

To assess a computer-aided technology for assisting writing in a man who emerged from a minimally conscious state and presented with extensive motor disabilities.

METHOD

The technology served to present letters, in groups, at the centre of a computer screen and display (write) the letters selected by the man (i.e. through a simplified pointing response) on the upper half of that screen.

RESULTS

The results showed that the technology enabled the man to produce clear (readily readable) writing. This writing compared positively with the results obtained using a communication board containing the letters (i.e. a system already available to the man).

CONCLUSION

Computer-aided technology may provide basic writing (communication) opportunities to persons emerged from a minimally conscious state and affected by extensive motor disabilities and lack of speech.

"Say Cheese": teaching photography skills to adults with developmental disabilities

We evaluated a video prompting procedure to teach adults with developmental disabilities to take a digital photograph and print it using a laptop computer and a printer. Participants were four men with developmental disabilities. Training was conducted at the participants' residential facility. During baseline, participants were told to take a photograph, but were given no other instruction. During intervention, participants received instruction using a video prompting procedure. Video prompting consisted of watching a clip of each step of the task analysis and then having the opportunity to imitate that step. Video prompting was evaluated using a multiple-probe across participants design. Following acquisition, video prompting was removed to assess maintenance at 2, 4 and 8 weeks and at 6 months. During naturalistic probes, participants had the opportunity to take a picture of their choice of flora, surroundings or persons. All four participants learned to take and print a digital photograph with the video prompting procedures. The skills generalized to novel situations and were maintained at each follow-up probe. These data suggest that video prompting may be an effective instructional strategy for teaching digital photography skills to adults with developmental 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.

Promoting mouth-drying responses to reduce drooling effects by persons with intellectual and multiple disabilities: a study of two cases

This study assessed the use of microswitch technology to promote mouth-drying responses and thereby reduce the effects of drooling by two adults with severe intellectual and multiple disabilities. Mouth-drying responses were performed via a special napkin that contained pressure sensors, a microprocessor and an MP3 to monitor the responses and ensure positive stimulation contingent on them. Initially, the responses produced 10 or 15 s of preferred stimulation. Subsequently, preferred stimulation was supplemented with matching periods of lower-grade stimulation to extend the inter-response intervals. Results showed that both participants (a) learned to dry their mouth consistently and reduce their chin wetness during the intervention, (b) stabilized their responding at lower frequencies as the lower-grade stimulation was added to the preferred stimulation, and (c) maintained the latter levels at a 3-month follow-up. Procedure and response conditions and outcome implications are discussed.

Problem behavior during preference assessments: an empirical analysis and practical recommendations

Preferences of 2 children with developmental disabilities, whose functional analyses indicated that their problem behavior was maintained by access to tangible items, were assessed using three formats (i.e., paired stimulus [PS], multiple-stimulus without replacement [MSWO], and free operant [FO]). The experimenter administered each format five times and compared levels of problem behavior across formats in a multielement design. Both participants exhibited problem behavior in PS and MSWO formats but not in the FO format. Results are discussed in terms of recommendations for practitioners.

A Verbal-Instruction System to Help a Woman With Intellectual Disability and Blindness Manage Food- and Drink-Preparation Tasks

A new verbal-instruction system, which ensured the presentation of step instructions automatically, was used to help a woman with moderate intellectual disability and blindness perform food- and drink-preparation tasks. During Part I of the study, this system was compared with a system requiring the woman to seek instructions on her own. Two tasks were used, one with each system. During Part II of the study, the new system was applied with four additional tasks. The results of Part I showed the following: (a) the woman’s level of correct performance on the task carried out with the new system was higher than the level on the other task and (b) performance of this latter task improved when the new system was used with it. The results of Part II showed satisfactory performance with all four tasks carried out with the new system. The implications of these data were discussed.

Examining the function of problem behavior in fragile X syndrome: preliminary experimental analysis

Fragile X syndrome is the most common inherited cause of intellectual and developmental disability. The influence of environmental variables on behaviors associated with the syndrome has received only scant attention. The current study explored the function served by problem behavior in fragile X syndrome by using experimental functional analysis methodology with 8 children with fragile X. No child met criteria for attention-maintained problem behavior, 5 children met criteria for escape-maintained problem behavior, and 4 children met criteria for tangible-maintained problem behavior. Results are discussed and compared with previous findings on the function of problem behavior in fragile X syndrome, and implications for intervention are discussed. It is noted that the external validity of these findings is limited by the small sample size.

Persons with multiple disabilities use orientation technology to find room entrances during indoor traveling

These two studies assessed adapted orientation technology for promoting correct direction and room identification during indoor traveling by persons with multiple (e.g., sensory, motor and intellectual/adaptive) disabilities. In Study I, two adults were included who had severe visual impairment or total blindness and deafness and used a wheelchair for traveling. In Study II, two adults participated who had visual impairment or total blindness but were ambulatory. All participants were to travel to different rooms located along a hallway to carry out small activities. The orientation technology ensured that the participants received (a) a verbal instruction to go to their right or left and/or a vibratory cue to the right or left side of their body as soon as they exited a room to orient their travel within the hallway and (b) a similar verbal instruction and/or vibratory cue to turn and enter when they reached the next target room entrance. Results of both studies showed that the participants on wheelchairs and those able to ambulate were successful in using the technology, orient their travel, and find the appropriate room entrances. The findings are discussed in relation to the importance of independent indoor traveling and the impact of the new technology.

Technology-aided verbal instructions to help persons with mild or moderate Alzheimer's disease perform daily activities

These two studies extended previous research on the use of verbal instructions and support technology for helping persons with mild or moderate Alzheimer's disease perform daily activities. Study I included seven participants who were to carry out one of two previously targeted activities (i.e., either coffee preparation or table setting). Study II included four participants who were to carry out two new activities (i.e., preparation of a fruit salad and of a vegetable salad). The effects of activity engagement on mood (i.e., indices of happiness) were assessed by recording the participants' behavior during the activity trials and parallel non-activity periods. The participants of Study I reached percentages of correct activity performance, which normally exceeded 85. Five of them also showed higher indices of happiness during the activity trials as opposed to the non-activity periods. Three of the participants of Study II reached high percentages of correct performance on both activities available. One of these participants also showed higher indices of happiness during the activity trials. The findings were discussed in relation to previous research outcomes and in terms of their practical implications for intervention programs.

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.

An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state

This paper presents an overview of the studies directed at helping post-coma persons with minimally conscious state improve their adaptive behavior. Twenty-one studies were identified for the 2000-2010 period (i.e., a period in which an intense debate has occurred about diagnostic, rehabilitative, prognostic, and ethical issues concerning people with severe acquired brain injury). Three of the 21 studies involved transcortical magnetic or deep brain stimulation. Six studies focused on the provision of multisensory stimulation or music therapy. The remaining 12 studies involved the use of response-related (contingent) stimulation and assistive technology. The outcomes of the studies, which were generally reported as positive, were discussed in terms of (a) the size (quantitative relevance) of the changes obtained, (b) the credibility/reliability of the changes, in light of the methodological conditions of the studies, and (c) the level of engagement and interaction involvement of the participants. Relevant issues for future research were also examined.

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.

Behavioral Intervention Promotes Successful Use of an iPod-Based Communication Device by an Adolescent With Autism

Individuals with autism and limited speech are candidates for speech-generating devices (SGDs), but some individuals might experience difficulty in operating these devices. We describe the case of Steven, a 17-year-old adolescent with autism who used an iPod-based SGD, but had difficulty activating the speech output feature of this device. His difficulties were initially interpreted as motor control problems, suggesting the need to abandon this technology, prescribe a different SGD, or adapt his existing device. An alternative conceptualization was that the existing intervention procedures had failed to shape more effective response topographies. Along these lines, a behavioral intervention, involving differential reinforcement and delayed prompting, proved effective in shaping response topographies that enabled Steven to be more successful in activating the speech output function of his iPod-based SGD. The results suggest that behavioral intervention may provide an alternative to the more costly and involved process of replacing or modifying the person’s SGD.