Assisting patients with disabilities to actively perform occupational activities using battery-free wireless mice to control environmental stimulation

Investigating immediacy in multiple-phase-change single-case experimental designs using a Bayesian unknown change-points model

Immediacy is one of the necessary criteria to show strong evidence of treatment effect in single-case experimental designs (SCEDs). However, with the exception of Natesan and Hedges (2017), no inferential statistical tool has been used to demonstrate or quantify it until now. We investigate and quantify immediacy by treating the change points between the baseline and treatment phases as unknown. We extend Natesan and Hedges' work to multiple-phase-change (e.g. ABAB) designs using a variational Bayesian (VB) unknown change-point model. VB was used instead of Markov chain Monte Carlo methods (MCMC), because MCMC cannot be used effectively to determine multiple change points. Combined and individual probabilities of correctly estimating the change points were used as indicators of the algorithm's accuracy. Unlike MCMC in the Natesan and Hedges (2017) study, the VB method was able to recover the change points with high accuracy even for short time series and in only a fraction of the time for all time-series lengths. We illustrate the algorithm with 13 real data sets. Additionally, we discuss the advantages of the unknown change-point approach, and the Bayesian and variational Bayesian estimation for SCEDs.

Assistive technology to help persons in a minimally conscious state develop responding and stimulation control: Performance assessment and social rating

BACKGROUND

Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated.

OBJECTIVE

This study aimed to (a) further assess a technology-aided approach for fostering MCS participants' responding and stimulation control and (b) carry out a social validation check about the approach.

METHODS

Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check.

RESULTS

The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants.

CONCLUSIONS

A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.

Supporting self-managed leisure engagement and communication in post-coma persons with multiple disabilities

Post-coma persons affected by extensive motor impairment and lack of speech, with or without disorders of consciousness, need special support to manage leisure engagement and communication. These two studies extended research efforts aimed at assessing basic technology-aided programs to provide such support. Specifically, Study I assessed a program for promoting independent stimulation choice in four post-coma persons who combined motor and speech disabilities with disorders of consciousness (i.e., were rated between the minimally conscious state and the emergence from such state). Study II assessed a program for promoting independent television operation and basic communication in three post-coma participants who, contrary to those involved in Study I, did not have disorders of consciousness (i.e., had emerged from a minimally conscious state). The results of the studies were largely positive with substantial levels of independent stimulation choice and access for the participants of Study I and independent television operation and communication for the participants of Study II. The results were analyzed in relation to previous data in the area and in terms of their implications for daily contexts dealing with these persons.

Technology-aided programs for post-coma patients emerged from or in a minimally conscious state

Post-coma persons in a minimally conscious state (MCS) or emerged/emerging from such state (E-MCS), who are affected by extensive motor impairment and lack of speech, may develop an active role and interact with their environment with the help of technology-aided intervention programs. Although a number of studies have been conducted in this area during the last few years, new evidence about the efficacy of those programs is warranted. These three studies were an effort in that direction. Study I assessed a technology-aided program to enable six MCS participants to access preferred environmental stimulation independently. Studies II and III assessed technology-aided programs to enable six E-MCS participants to make choices. In Study II, three of those participants were led to choose among leisure and social stimuli, and caregiver interventions automatically presented to them. In Study III, the remaining three participants were led to choose (a) among general stimulus/intervention options (e.g., songs, video-recordings of family members, and caregiver interventions); and then (b) among variants of those options. The results of all three studies were largely positive with substantial increases of independent stimulation access for the participants of Study I and independent choice behavior for the participants of Studies II and III. The results were analyzed in relation to previous data and in terms of their implications for daily contexts working with MCS and E-MCS persons affected by multiple disabilities.

Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard

The principle of this study was to use the finger-pressing position detection program (FPPDP) with a standard keyboard to improve the fine motor activities of disabled people through environmental stimulation. The FPPDP is a software solution which turns a standard keyboard into a finger-pressing position detector. By using this technique, this study tried to find out whether two students with developmental disabilities would be able to effectively perform fine motor activities through the triggering of environmental stimulation. This study was based on an ABAB design and the results showed that both participants demonstrated an obvious increase in terms of their willingness to perform target responses during the intervention phases. The practical and developmental implications of the findings are discussed.

Technology-based intervention programs to promote stimulation control and communication in post-coma persons with different levels of disability

Post-coma persons in a minimally conscious state and with extensive motor impairment or emerging/emerged from such a state, but affected by lack of speech and motor impairment, tend to be passive and isolated. A way to help them develop functional responding to control environmental events and communication involves the use of intervention programs relying on assistive technology. This paper provides an overview of technology-based intervention programs for enabling the participants to (a) access brief periods of stimulation through one or two microswitches, (b) pursue stimulation and social contact through the combination of a microswitch and a sensor connected to a speech generating device (SGD) or through two SGD-related sensors, (c) control stimulation options through computer or radio systems and a microswitch, (d) communicate through modified messaging or telephone systems operated via microswitch, and (e) control combinations of leisure and communication options through computer systems operated via microswitch. Twenty-six studies, involving a total of 52 participants, were included in this paper. The intervention programs were carried out using single-subject methodology, and their outcomes were generally considered positive from the standpoint of the participants and their context. Practical implications of the programs are discussed.

Assisting people with disabilities in actively performing physical activities by controlling the preferred environmental stimulation with a gyration air mouse

The latest researchers have employed software technology to turn gyration air mice into a high performance limb detector to detect specific limb movement, and to further collaborate using the preferred environmental stimulation to help people with disabilities to suppress unwanted behaviors or habits and to reward good behaviors. This study extended the functionality of a gyration air mouse, and used the mouse as a precise physical activity detector integrated with the preferred environmental stimulation to assess if this integrated set can be used to help two disabled people who are overweight and lacking in exercise to actively perform physical activities. The study was conducted based on an A-B-A-B design. The results showed that both participants increased significantly the time duration required for them to maintain their physical activity status so that they could obtain their favorite environmental stimulation during the intervention phases. Both the practical and developmental implications of the findings are then discussed.

Assisting people with disabilities in actively performing designated occupational activities with battery-free wireless mice to control environmental stimulation

The latest researches use software technology (OLDP, object location detection programs) to turn a commercial high-technology product, i.e. a battery-free wireless mouse, into a high performance/precise object location detector to detect whether or not an object has been placed in the designated location. The preferred environmental stimulation is also incorporated to assist those patients in need of occupational activities in performing simple occupational activities to acquire their preferred environmental stimulation. The result of the experiment shows that both participants have been able to control their preferred environmental stimulation by actively performing occupational activities. This study is going to extend the aforementioned researches by using battery-free wireless mice to assist patients in performing more complicated occupational activities. The ABAB design has been adopted for experiments, and the result shows that during intervention phrases, the occupational activities of both participants are significantly improved.

Technology-aided leisure and communication opportunities for two post-coma persons emerged from a minimally conscious state and affected by multiple disabilities

This study assessed technology-aided programs for helping two post-coma persons, who had emerged from a minimally conscious state and were affected by multiple disabilities, to (a) engage with leisure stimuli and request caregiver's procedures, (b) send out and listen to text messages for communication with distant partners, and (c) combine leisure engagement and procedure requests with text messaging within the same sessions. The program for leisure engagement and procedure requests relied on the use of a portable computer with commercial software, and a microswitch for the participants' response. The program for text messaging communication involved the use of a portable computer, a GSM modem, a microswitch for the participants' response, and specifically developed software. Results indicated that the participants were successful at each of the three stages of the study, thus providing relevant evidence concerning performance achievements only minimally documented. The implications of the findings in terms of technology and practical opportunities for post-coma persons with multiple disabilities are discussed.