From assistive to inclusive? A systematic review of the uses and effects of technology to support people with pervasive support needs

BACKGROUND

Although particular technologies can enhance the quality of life (QoL) of people with profound intellectual and multiple disabilities (we use the term pervasive support needs), their objectives and outcomes are understudied. A systematic literature review was therefore conducted to explore this topic.

METHOD

A search of four databases yielded 64 studies. Data were extracted on their general characteristics, methods and sample characteristics as well as the technology types, QoL domains and application within ecological systems. A narrative synthesis was subsequently developed.

RESULTS

Most of the studies applied assistive technology (AT) and focused on personal development and self-determination on an individual level.

CONCLUSIONS

Technology can enhance the QoL of people with pervasive support needs. There are indications that although MT and UD-based technology are used in practice, few studies have examined these technologies. Therefore, there is a knowledge gap regarding the kinds of technology that are used in practice.

Multilevel linear modelling of the response-contingent learning of young children with significant developmental delays

AIM

The purpose of the study was to isolate the sources of variations in the rates of response-contingent learning among young children with multiple disabilities and significant developmental delays randomly assigned to contrasting types of early childhood intervention.

METHOD

Multilevel, hierarchical linear growth curve modelling was used to analyze four different measures of child response-contingent learning where repeated child learning measures were nested within individual children (Level-1), children were nested within practitioners (Level-2), and practitioners were nested within the contrasting types of intervention (Level-3).

RESULTS

Findings showed that sources of variations in rates of child response-contingent learning were associated almost entirely with type of intervention after the variance associated with differences in practitioners nested within groups were accounted for. Rates of child learning were greater among children whose existing behaviour were used as the building blocks for promoting child competence (asset-based practices) compared to children for whom the focus of intervention was promoting child acquisition of missing skills (needs-based practices).

IMPLICATIONS

The methods of analysis illustrate a practical approach to clustered data analysis and the presentation of results in ways that highlight sources of variations in the rates of response-contingent learning among young children with multiple developmental disabilities and significant developmental delays.

Contrasting approaches to the response-contingent learning of young children with significant delays and their social-emotional consequences

AIMS

The purpose of the analyses described in this paper was to evaluate the direct and indirect effects of two different approaches to child response-contingent learning on rates of child learning and both concomitant and collateral child social-emotional behaviour.

METHOD

The participants were 71 children with significant developmental delays or multiple disabilities randomly assigned to either of the two contrasting approaches to interventions.

RESULTS

Findings showed that an intervention which employed practices that built on existing child behaviour (asset-based practices) was more effective than an intervention focusing on teaching children missing skills (needs-based practices) for influencing changes in the rates of child learning as well as rates of child social-emotional behaviour mediated by differences in rates of child learning.

IMPLICATIONS

Both the theoretical and practical importance of the results are described in terms of the extended social-emotional benefits of asset-based response-contingent learning games.

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.

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.

A voice-detecting sensor and a scanning keyboard emulator to support word writing by two boys with extensive motor disabilities

The present study assessed the use of a voice-detecting sensor interfaced with a scanning keyboard emulator to allow two boys with extensive motor disabilities to write. Specifically, the study (a) compared the effects of the voice-detecting sensor with those of a familiar pressure sensor on the boys' writing time, (b) checked which of the sensors the boys preferred, and (c) conducted a social validation assessment of the boys' performance with the two sensors, employing psychology students as raters. The difference in the boys' overall mean writing time per letter across sensors was, by the end of the study, about 1.5s. This difference favored the pressure sensor for one of the boys and the voice-detecting sensor for the other boy. Both boys showed preference for the voice-detecting sensor. Moreover, the psychology students involved in the social validation assessment indicated that such sensor was more satisfactory, suitable, and educationally relevant than the pressure sensor, and represented the solution that they as raters supported more.

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.

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.

Micro-switch programmes for students with multiple disabilities and minimal motor behaviour: assessing response acquisition and choice

This study assessed (a) whether three girls with multiple disabilities and minimal motor behaviour could acquire pairs of responses taught through micro-switch-based programmes and (b) how the girls would eventually choose between those responses. In relation to the choice issue, a response-choice analysis was conducted to find out whether possible differences in performance rates for the two responses were due to the stimuli linked to them and/or to potential response preferences. Results indicated that all three girls succeeded in the acquisition of the two responses programmed for them and showed clear response choices. The choices seemed to be largely motivated by the stimuli linked to the responses. Implications of these findings were discussed, including the need to assess their generality and extend the scope of the work in this area.