Impact of AI-Powered Solutions in Rehabilitation Process: Recent Improvements and Future Trends

Rehabilitation is an important and necessary part of local and global healthcare services along with treatment and palliative care, prevention of disease, and promotion of good health. The rehabilitation process helps older and young adults even children to become as independent as possible in activities of daily life and enables participation in useful living activities, recreation, work, and education. The technology of Artificial Intelligence (AI) has evolved significantly in recent years. Many activities related to rehabilitation have been getting benefits from using AI techniques. The objective of this review study is to explore the advantages of AI for rehabilitation and how AI is impacting the rehabilitation process. This study aims at the most critical aspects of the rehabilitation process that could potentially take advantage of AI techniques including personalized rehabilitation apps, rehabilitation through assistance, rehabilitation for neurological disorders, rehabilitation for developmental disorders, virtual reality rehabilitation, rehabilitation of neurodegenerative diseases and Telerehabilitation of Cardiovascular. We presented a survey on the newest empirical studies available in the literature including the AI-based technology helpful in the Rehabilitation process. The novelty feature included but was not limited to an overview of the technological solutions useful in rehabilitation. Seven different categories were identified. Illustrative examples of practical applications were detailed. Implications of the findings for both research and practice were critically discussed. Most of the AI applications in these rehabilitation types are in their infancy and continue to grow while exploring new opportunities. Therefore, we investigate the role of AI technology in rehabilitation processes. In addition, we do statistical analysis of the selected studies to highlight the significance of this review work. In the end, we also present a discussion on some challenges, and future research directions.

An assistive technology program for enabling five adolescents emerging from a minimally conscious state to engage in communication, occupation, and leisure opportunities

BACKGROUND

Post-coma patients emerging from a minimally conscious state may have extensive motor disabilities and pose serious challenges to medical centers and home settings.

OBJECTIVES

To promote academic performance and communication skills of post-coma individuals with traumatic brain injuries emerging from a minimally conscious state through an Assistive Technology setup. To evaluate its effects on the participants' positive participation. To generalize the learning process. To assess the intervention's clinical and social validity.

METHOD

Study I included five adolescents exposed to an Assistive Technology setup enabling them with targeted adaptive behaviors. Study II involved fifty external raters in a social validation assessment.

RESULTS

Data evidenced an improved performance of all the participants during the intervention, assessed through a concurrent multiple baseline design across participants. Social raters favorably scored the use of the technology.

CONCLUSION

An Assistive Technology setup may be helpful to enhance the performance and positive participation of adolescents with traumatic brain injuries emerging from a minimally conscious state.

The Prevalence of Amnestic and Non-Amnestic Mild Cognitive Impairment and Its Association with Different Lifestyle Factors in a South Italian Elderly Population

Mild Cognitive Impairment (MCI) is a transition stage between normal aging and dementia and can be useful to monitor the cognitive status of people at risk of dementias. Our aims were to investigate the prevalence of amnestic and non-amnestic MCI in a South Italian elderly population, and to identify socio-demographic, clinical and lifestyle factors associated with MCI. A cross-sectional retrospective population study on 839 community-dwelling participants over 60 years of age was carried out. Elderly people were administered a brief neuropsychological screening to identify their cognitive and functional status, and a questionnaire to investigate several socio-demographic, clinical, and lifestyle factors. Prevalence estimate for MCI was 12.0% (95% CI: 10.0–14.5%), for amnestic MCI was 7.4% (95% CI: 5.8–9.4%), and for non-amnestic MCI was 4.6% (95% CI: 3.4–6.4%), for people older than 60 years of age. Logistic regression models, corrected for age, sex, and education, revealed a significant association of MCI with the following factors: age, education, intellectual activities, and topographical disorientation. On the other hand, education, clinical factors (e.g., depression level and perceived physical pain), lifestyle factors (e.g., smoking, alcohol, and leisure/productive activities), dietary habits, quality of life, and self-reported topographical disorientation were non-significantly associated with MCI. Prevalence estimates and the association of MCI and its subtypes with risk and protective factors were discussed in comparison with the most recent systematic reviews and meta-analyses.

Virtual Reality as a Technological-Aided Solution to Support Communication in Persons With Neurodegenerative Diseases and Acquired Brain Injury During COVID-19 Pandemic

The COVID-19 poses an ongoing threat to lives around the world and challenges the existing public health and medical service delivery. The lockdown or quarantine measures adopted to prevent the spread of COVID-19 has caused the interruption in ongoing care and access to medical care including to patients with existing neurological conditions. Besides the passivity, isolation, and withdrawal, patients with neurodegenerative diseases experience difficulties in communication due to a limited access to leisure opportunities and interaction with friends and relatives. The communication difficulties may exacerbate the burden on the caregivers. Therefore, assistive-technologies may be a useful strategy in mitigating challenges associated with remote communication. The current paper presents an overview of the use of assistive technologies using virtual reality and virtual body ownership in providing communication opportunities to isolated patients, during COVID-19, with neurological diseases and moderate-to-severe communication difficulties. We postulate that the assistive technologies-based intervention may improve social interactions in patients with neurodegenerative diseases and acquired brain injury-thereby reducing isolation and improving their quality of life and mental well-being.

Cognitive Telerehabilitation for Older Adults With Neurodegenerative Diseases in the COVID-19 Era: A Perspective Study

The COVID-19 pandemic is a global health problem that is radically transforming public and private healthcare organizations around the world, negatively affecting the rehabilitative treatments of non-COVID pathologies as well. In this situation, it becomes crucial to be able to guarantee the continuity of care also to all those patients with neurodegenerative diseases unable to reach healthcare services. Remote communication technologies are gaining momentum as potentially effective options to support health care interventions-including cognitive rehabilitation-while patients can stay safely at home. In this context, we are implementing HomeCoRe (i.e., Home Cognitive Rehabilitation software) in order to offer an innovative approach and a valid support for home-based cognitive rehabilitation in neurodegenerative diseases, such as mild cognitive impairment and early dementia. HomeCoRe has been developed within a research project between engineers and clinicians in order to obtain a usable and safe cognitive rehabilitation tool. This software has multiple advantages for patients and therapists over traditional approaches, as shown in its use in hospital settings. HomeCoRe could then represent an opportunity for accessing cognitive rehabilitation in all those situations where patients and therapists are not in the same location due to particular restrictions, such as COVID-19 pandemic.

The Drives for Driving Simulation: A Scientometric Analysis and a Selective Review of Reviews on Simulated Driving Research

Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors' keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic.

The differential effect of normal and pathological aging on egocentric and allocentric spatial memory in navigational and reaching space

BACKGROUND

Topographical disorientation (TD) refers to a particular condition which determines the loss of spatial orientation, both in new and familiar environments. TD and spatial memory impairments occur relatively early as effect of cognitive decline in aging, even in prodromal stages of dementia, namely mild cognitive impairment (MCI).

AIMS

(a) To show that components linked to the recall of familiar spatial knowledge are relatively spared with respect to the learning of unfamiliar ones in normal aging, while they are not in MCI, and (b) to investigate gender differences for their impact on egocentric and allocentric frames of reference.

METHOD

Forty young participants (YC), 40 healthy elderly participants (HE), 40 elderly participants with subjective memory complaints (SMC), and 40 elderly with probable MCI were administered with egocentric and allocentric familiar tasks, based on the map of their hometown, and with egocentric and allocentric unfamiliar tasks, based on new material to be learned. A series of general linear models were used to analyze data.

RESULTS

No group differences were found on egocentric task based on familiar information. MCI performed worse than the other groups on allocentric tasks based on familiar information (YC = HE = SMC > MCI). Significant differences emerged between groups on egocentric and allocentric tasks based on unfamiliar spatial information (YC > HE = SMC > MCI). A gender difference was found, favoring men on allocentric unfamiliar task.

CONCLUSION

Familiarity of spatial memory traces can represent a protective factor for retrospective components of TD in normal aging. Conversely, using newly learned information for assessment may lead to overestimating TD severity.

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.

Spatial reorientation decline in aging: the combination of geometry and landmarks

OBJECTIVES

The study is focused on the assessment of reorientation skills in a sample of community-dwelling elderly people, manipulating landmarks and geometric (layout) information.

METHOD

A neuropsychological assessment was administered to 286 elderly participants, divided into six groups (healthy controls, HC; four subgroups of participants with mild cognitive impairment, MCI; participants with probable dementia, Prob_D) and tested with the Virtual Reorientation Test (VReoT). VReoT manipulated different spatial cues: geometry and landmarks (proximal and distal).

RESULT

Compared with HC, participants with MCI and Prob_D showed to be impaired in tasks involving geometry, landmarks and a combination of them. Both single and multiple domain impairment in MCI had an impact on reorientation performance. Moreover, VReoT was marginally able to discriminate between amnesic and non-amnesic MCI. The occurrence of getting lost events seemed to be associated to learning of geometric information.

CONCLUSION

The associative strength between landmark and target plays an important role in affecting spatial orientation performance of cognitively impaired participants. Geometry significantly supports landmark information and becomes helpful with the increase of cognitive impairment which is linked to a decrement in landmark encoding. VReoT seems to represent a reliable evaluation supplement for spatial orientation deficits in prodromal stages of dementia.

Assistive technology to promote occupation and reduce mouthing by three boys with fragile X syndrome

OBJECTIVES

To extend the use of assistive technology (AT) for promoting a new adaptive response and to reduce hand mouthing, by three boys with fragile X syndrome. To monitor the effects of the intervention program on the positive mood. To carry out a three month follow-up phases. To conduct a social validation assessment involving 30 parents of children who presented multiple disabilities as raters.

METHODS

The study was implemented according to an ABAB experimental design, where A represented baseline phases (technology available but inactive) and B represented intervention phases (the technology ensured 7 s of positive stimulation).

RESULTS

All participants improved and consolidated their performance. Parents involved in the social validation assessment rated positively the use of such technology.

CONCLUSION

AT-based program was useful, affordable, and effective for enhancing constructive engagement, self-determination, and for improving quality of life by children with fragile X syndrome and severe to profound developmental disabilities.

A microswitch-based program for promoting initial ambulation responses: An evaluation with two girls with multiple disabilities

We assessed the use of a microswitch-based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid.

The role of pre-morbid intelligence and cognitive reserve in predicting cognitive efficiency in a sample of Italian elderly

BACKGROUND

Models of cognitive reserve in aging suggest that individual's life experience (education, working activity, and leisure) can exert a neuroprotective effect against cognitive decline and may represent an important contribution to successful aging.

AIM

The objective of the present study is to investigate the role of cognitive reserve, pre-morbid intelligence, age, and education level, in predicting cognitive efficiency in a sample of healthy aged individuals and with probable mild cognitive impairment.

METHODS

Two hundred and eight aging participants recruited from the provincial region of Bari (Apulia, Italy) took part in the study. A battery of standardized tests was administered to them to measure cognitive reserve, pre-morbid intelligence, and cognitive efficiency. Protocols for 10 participants were excluded since they did not meet inclusion criteria, and statistical analyses were conducted on data from the remaining 198 participants. A path analysis was used to test the following model: age, education level, and intelligence directly influence cognitive reserve and cognitive efficiency; cognitive reserve mediates the influence of age, education level, and intelligence on cognitive efficiency.

RESULTS

Cognitive reserve fully mediates the relationship between pre-morbid intelligence and education level and cognitive efficiency, while age maintains a direct effect on cognitive efficiency.

DISCUSSION

Cognitive reserve appears to exert a protective effect regarding cognitive decline in normal and pathological populations, thus masking, at least in the early phases of neurodegeneration, the decline of memory, orientation, attention, language, and reasoning skills.

CONCLUSIONS

The assessment of cognitive reserve may represent a useful evaluation supplement in neuropsychological screening protocols of cognitive decline.

Adapting a Grid into a Microswitch to Suit Simple Hand Movements of a Child with Profound Multiple Disabilities

We adapted a grid into a microswitch for the hand movements of a girl with profound multiple disabilities who lay on her back. The grid, suspended above the girl's face, was equipped with two mercury devices, i.e., small sealed ampoules containing a mercury drop and ending with conductive leads. A lateral or forward movement of the grid would make the mercury drop of at least one device slide to the conductive leads and activate the device. During the intervention, activations of the devices, i.e., microswitch activations, produced the occurrence of favorite stimuli. Analysis showed that the girl increased the frequency of hand movements and microswitch activations during the intervention phases compared to the baseline phases (when the favorite stimuli were not available). The increase was retained at a 1-mo. postintervention check.

Assistive technology to promote leisure and constructive engagement by two boys emerged from a minimal conscious state

BACKGROUND

Post-coma persons with multiple disabilities may represent a challenge to rehabilitation centers, due to their clinical conditions. Moreover, they can failed to engage adaptive responses aimed at the self-management of environmental stimuli.

OBJECTIVES

To assess the impact and social rating of a new assistive technology set-up for promoting constructive engagement by two post-coma boys emerged from a minimal conscious state.

METHOD

During baseline sessions, the participants were provided with a mouse to manage the computer system. During intervention phases, a new technology was implemented, allowing both participants to manage environmental stimuli with a microswitch instead of the mouse. Furthermore, a social validation assessment was carried out, involving students as raters.

RESULTS

Data showed an increasing of constructive engagement by both participants during intervention phases. Sixty psychology students (social raters) favoured the new technology on a six items questionnaire (i.e. enjoyment, suitability, rehabilitation, independence, daily context and support).

CONCLUSIONS

The new technology was suitable, affordable, effective and socially preferable.

Technological aids to support choice strategies by three girls with Rett syndrome

This study was aimed at extending the use of assistive technology (i.e., photocells, interface and personal computer) to support choice strategies by three girls with Rett syndrome and severe to profound developmental disabilities. A second purpose of the study was to reduce stereotypic behaviors exhibited by the participants involved (i.e., body rocking, hand washing and hand mouthing). Finally, a third goal of the study was to monitor the effects of such program on the participants' indices of happiness. The study was carried out according to a multiple probe design across responses for each participant. Results showed that the three girls increased the adaptive responses and decreased the stereotyped behaviors during intervention phases compared to baseline. Moreover, during intervention phases, the indices of happiness augmented for each girl as well. Clinical, psychological and rehabilitative implications of the findings are discussed.

Technological supports to promote choice opportunities by two children with fragile X syndrome and severe to profound developmental disabilities

This study was aimed at assessing whether technological supports (i.e. optic sensors such as photocells) were successful enabling two boys with fragile X syndrome and severe to profound developmental disabilities to perform occupation and choice opportunities. A second goal of the study was to reduce stereotyped behaviours (i.e. hand mouthing and eye poking) exhibited by the participants. Finally, the third purpose of the study was to verify the rehabilitative effects of the intervention program on the indices of happiness of the participants. The study has been conducted according to a non-concurrent multiple baseline design across participants followed by intervention and cross over phases, where the associations between behavioural responses and environmental consequences were systematically inverted. Moreover, a maintenance phase was assessed. The results demonstrated that the technology is useful to facilitate employment and opportunities of choice, showing a growth of the indices of happiness and a decrease of stereotyped behaviours, from both participants involved. Clinical, practical and psychological implications of the findings are discussed.

Persons with moderate Alzheimer's disease use simple technology aids to manage daily activities and leisure occupation

Two studies assessed technology-aided programs to support performance of daily activities and selection/activation of music items with patients with moderate Alzheimer's disease. In Study I, four patients were presented with activity-related pictorial instructions via a computer fitted with inexpensive, commercial software. In Study II, four patients were (a) presented with different music options and (b) allowed to select and activate the preferred option via a microswitch response. Study I showed that each patient learned to perform the two activities available with percentages of correct responses exceeding 85 by the end of the intervention. Study II showed that all patients learned to choose and activate music options. Psychology students, employed in a social validation check, scored the patients' behavior within the program better than their behavior in a control situation. The relevance and usability of simplified pictorial-instruction programs and music choice programs for patients with moderate Alzheimer's disease were discussed.

Comparing two different orientation strategies for promoting indoor traveling in people with Alzheimer's disease

The present study compared two different types of orientation strategies: an assistive technology program (AT, i.e., remotely controlled sound/light devices) and a backward chaining procedure (BC) for promoting indoor traveling in four persons with moderate to severe Alzheimer's disease (AD). A social validation assessment of the two strategies was also conducted employing undergraduate students as raters. For three out of four participants, AT intervention was more effective than the BC procedure, whilst for the fourth participant the two types of intervention had a comparably satisfying efficacy. A doubly Multivariate Analysis of Variance on social validation assessment data provided generally more positive scores for the AT intervention. These results suggest that AT programs (a) can be valuably employed for restoring and maintaining independence in indoor traveling in people with moderate to severe AD, and (b) might be perceived as preferable to conventional teaching strategies within daily contexts.

Assistive technology for promoting choice behaviors in three children with cerebral palsy and severe communication impairments

A technology-based program to promote independent choice behaviors by three children with cerebral palsy and multiple disabilities was assessed. The program was based on learning principles and assistive technology (i.e., customized input devices/sensors, personal computers, screening of preferred stimuli according to a binomial criterion). The first purpose of the present study was to provide the participants with a new set-up of assistive technology and to allow them to choose among three categories (i.e., food, beverage and leisure), and to request a specific item out of four in each category, adopting a procedure that minimized (according to a conditional probability criterion) unintentional choices. The second aim of the study was to carry out the effects of the program on detectable mood signs (i.e., happiness index). The study was conducted according to an ABAB sequence with a subsequent post intervention check for each participant. The results showed an increase of engagement and of the happiness index during intervention phases. Psychological as well as educational implications were discussed.

Assessing the impact and social perception of self-regulated music stimulation with patients with Alzheimer's disease

We assessed the impact and social rating of an active and a passive music condition implemented with six patients with Alzheimer's disease. In the active condition, the patients used a simple hand response and a microswitch to self-regulate music stimulation inputs. In the passive condition, music stimulation was automatically presented throughout the sessions. Active and passive stimulation sessions were preceded and followed by control (non-stimulation) sessions. The active condition sessions showed an increase in the patients' indices of positive participation (e.g., singing or music-related movements, and smiles) greater than that observed in the passive condition sessions for five of the six patients. Positive intervention effects could also spread to the post-intervention sessions. Social raters (42 care and rehabilitation staff members working with persons with multiple disabilities) favored the active condition on a six-item questionnaire dealing with, among others, conditions' suitability, respect of patients' dignity and independence, and practicality. The implications of the findings as to the plausibility/desirability of an active stimulation condition were discussed.

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.

Promoting ambulation responses among children with multiple disabilities through walkers and microswitches with contingent stimuli

Children with severe or profound intellectual and motor disabilities often present problems of balance and ambulation and spend much of their time sitting or lying, with negative consequences for their development and social status. Recent research has shown the possibility of using a walker (support) device and microswitches with preferred stimuli to promote ambulation with these children. This study served as a replication of the aforementioned research and involved five new children with multiple disabilities. For four children, the study involved an ABAB design. For the fifth child, only an AB sequence was used. All children succeeded in increasing their frequencies of step responses during the B (intervention) phase(s) of the study, although the overall frequencies of those responses varied largely across them. These findings support the positive evidence already available about the effectiveness of this intervention approach in motivating and promoting children's ambulation. Practical implications of the findings are discussed.

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.

Fostering locomotor behavior of children with developmental disabilities: An overview of studies using treadmills and walkers with microswitches

This paper provides an overview of studies using programs with treadmills or walkers with microswitches and contingent stimulation to foster locomotor behavior of children with developmental disabilities. Twenty-six studies were identified in the period 2000-2008 (i.e., the period in which research in this area has actually taken shape). Twenty-one of the studies involved the use of treadmills (i.e., 13 were aimed at children with cerebral palsy, 6 at children with Down syndrome, and 2 at children with Rett syndome or cerebellar ataxia). The remaining five studies concerned the use of walkers with microswitches and contingent stimulation with children with multiple disabilities. The outcomes of the studies tended to be positive but occasional failures also occurred. The outcomes were analyzed considering the characteristics of the approaches employed, the implications of the approaches for the participants' overall functioning situation (development), as well as methodological and practical aspects related to those approaches. Issues for future research were also examined.

Enabling a young man with minimal motor behavior to manage independently his leisure television engagement

Persons with severe spastic tetraparesis and minimal motor behavior may be confined to a wheelchair or bed and have virtually no chances of constructive engagement with their immediate environment. A possible way to modify this situation may involve the use of technology. The present study (a) assessed specific technology to enable a young adult to manage his leisure television engagement independently and (b) carried out a social validation assessment of the technology-supported performance involving 90 teacher trainees as raters. The intervention period with the new technology included 67 sessions, during which the participant performed independently 392 of the 408 television-management responses, i.e., turning on the television, finding a channel with a preferred program, setting the volume, and turning off the television. He also indicated preference for using the technology as opposed to not using it. The raters provided relatively high (positive) scores for the technology-supported performance compared to the baseline performance. Implications of the findings are discussed.

Assessing the effects of stimulation versus microswitch-based programmes on indices of happiness of students with multiple disabilities

BACKGROUND

Stimulation and microswitch-based programmes are considered main strategies to promote indices of happiness in students with multiple disabilities. However, only limited attempts have been made to assess the relative effects of the two programmes. This study conducted such an assessment with seven students with multiple disabilities.

METHODS

The first four phases of the study served to: (1) provide the students with a systematic exposure to each of the programmes; and (2) measure the programmes' effects on indices of happiness by comparing them with baseline levels. The fifth phase served to compare the programmes with each other.

RESULTS

The first four phases of the study showed that the microswitch-based programme produced a significant increase in indices of happiness for all seven students, and the stimulation programme produced a significant increase for six students. During the fifth phase of the study (i.e. when the two programmes were alternated), the microswitch-based programme promoted significantly higher indices of happiness than the stimulation programme for four of the seven students.

CONCLUSIONS

Microswitch-based programmes might be deemed preferable to stimulation programmes because they can promote higher or comparable indices of happiness while promoting the acquisition of adaptive responses and self-determination.

A microswitch cluster to enhance arm-lifting responses without dystonic head tilting by a child with multiple disabilities

This study assessed whether a microswitch duster with favorite stimulation could help a 9.1-yr.-old child with multiple disabilities increase arm-lifting responses without dystonic, sideways head tilting. The microswitch cluster involved two microswitches, one at the child's arm to monitor the lifting response, and the other at the child's head to monitor whether it was tilted during arm lifting. Analysis showed that the percentage of arm-lifting responses occurring without head tilting increased most visibly when favorite stimulation focused on those (appropriate) responses.