Adele Boccasini

Persons with multiple disabilities increase adaptive responding and control inadequate posture or behavior through programs based on microswitch-cluster technology.

Study I used typical microswitch-cluster programs to promote adaptive responding (i.e., object manipulation) and reduce inappropriate head or head-trunk forward leaning with a boy and a woman with multiple disabilities. Optic, tilt, and vibration microswitches were used to record their adaptive responses while optic and tilt microswitches monitored their posture. The study included an ABB(1)AB(1) sequence, in which A represented baseline phases, B represented an intervention phase in which adaptive responses were always followed by preferred stimulation, and B(1) represented intervention phases in which the adaptive responses led to preferred stimulation only if the inappropriate posture was absent. Study II assessed a non-typical, new microswitch-cluster program to promote two adaptive responses (i.e., mouth cleaning to reduce drooling effects and object assembling) with a man with multiple disabilities. Initially, the man received preferred stimulation for each cleaning response. Then, he received stimulation only if mouth cleaning was preceded by object assembling. The results of Study I showed that both participants had large increases in adaptive responding and a drastic reduction in inappropriate posture during the B(1) phases and a 2-week post-intervention check. The results of Study II showed that the man learned to control drooling effects through mouth cleaning and used object assembling to extend constructive engagement and interspace cleaning responses functionally. The practical implications of the findings are discussed.

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.

Persons with multiple disabilities manage positive leisure and communication engagement through a technology-aided program

Objectives: Persons with multiple disabilities may frequently fail to achieve independent leisure engagement and communication with distant partners. The aim of this study was to extend the assessment of a technology-aided program providing support in the aforementioned areas with nine participants with multiple disabilities. Methods: The program involved a computer system presenting leisure and communication options and a microswitch allowing the participants to choose among and access those options. For each participant a specific array of options was available (e.g. songs, comedy videos, and text messages), depending on his or her characteristics and interests. The effects of the program were assessed via an ABAB design. Participants and staff’s opinions about the program were determined through preference checks and interviews. Results: During baseline (without the program), the participants failed to activate/access the options available and thus had no independent option-related engagement time. During intervention, all participants succeeded in using the program, thus accessing the options available independently, and remaining engaged with option-related events for generally 80–90% of the session time. Participants and staff were highly positive about the program. Conclusions: A technology-aided program adapted to the participants’ conditions can be a crucial resource to support their independent leisure and communication engagement.

Technology to support positive occupational engagement and communication in persons with multiple disabilities

Abstract Background: Persons with multiple (intellectual and sensory-motor) disabilities can have serious difficulties managing their independent engagement in leisure activities and communication, particularly with partners not present in their immediate environment. Methods: This study assessed two versions of a technology-aided program (involving a computer system to present leisure and communication options and a microswitch to choose among them) with four participants with multiple disabilities. Two participants used the first version of the program, which allowed them to choose among leisure (music) options. The other two participants used the second version of the program, which allowed them to choose among leisure (music and videos) and communication (telephone calls) options. Each program version was implemented according to a non-concurrent multiple baseline design across participants. Results: Data showed that both program versions were successful in helping the participants achieve the objectives pursued, that is, choose and access leisure or leisure and communication options independently. Conclusion: Technology-aided programs can enable persons with multiple disabilities to manage positive occupational engagement and communication.

Case studies of technology for adults with multiple disabilities to make telephone calls independently.

Recent literature has shown the possibility of enabling individuals with multiple disabilities to make telephone calls independently via computer-aided telephone technology. These two case studies assessed a modified version of such technology and a commercial alternative to it for a woman and a man with multiple disabilities, respectively. The modified version used in Study 1 (a) presented the names of the persons available for a call and (b) reminded the participant of the response she needed to perform (i.e., pressing a microswitch) if she wanted to call any of those names/persons. The commercial device used in Study 2 was a Galaxy S3 (Samsung) equipped with the S-voice module, which allowed the participant to activate phone calls by uttering the word ‘Call’ followed by the name of the persons he wanted to call. The results of the studies showed that the participants learned to make phone calls independently using the technology / device available. Implications of the results are discussed.

Assistive Technologies for Persons with Severe-Profound Intellectual and Developmental Disabilities

Abstract This chapter presents an overview of the assistive technology-based solutions available in the recent literature, illustrates their use, and summarizes some options with individuals who have severe to profound developmental disabilities, including multiple disabilities. Specifically, the text describes implementation of (i) one microswitch (i.e., allowing the independent access to preferred stimulation), (ii) two microswitches (i.e., enabling the participant with choice opportunities), (iii) a combination of microswitch and voice output communication aid (i.e., ensuring that the participant has independent access to preferred stimulation or social contact with a caregiver), (iv) microswitch-cluster (i.e., aimed at promoting an adaptive response and reducing a challenge behavior), (v) microswitch and computer (i.e., with the presentation of two or more categories of personal needs such as leisure, communication, literacy process, video, music and so forth), and (vi) microswitch and contingent stimulation (i.e., to foster ambulation responses or locomotion fluency). For each category, we give the empirical evidence, emphasizing the strengths and weaknesses of the selected studies. Furthermore, social validation assessments will be pointed out, as well as practical implications for future research.

Technology-based programs to improve walking behavior of persons with multiple disabilities: two single-case studies.

Purpose: Assessing two technology-based programs for reducing toe walking and breaks during walking of two men with multiple disabilities, respectively.Method: The men were involved in separate single-case studies, each of which was carried out according to an ABAB design. The technology included a microprocessor with specific software, optic sensors, and visual plus vibrotactile or auditory systems for presenting preferred stimuli. In Study I, the man received 1 s of preferred flickering lights and vibratory input for each step performed with the heel of the left foot touching the ground or coming close to it (i.e. within a 2-mm distance). In Study II, the other man received 10 s of preferred music anytime he crossed one of the small marks present along the travel routes. Results: The B phases showed that (a) the man included in Study I increased the percentages of left- and right-foot steps performed with the heels touching or nearing the ground to above 85% and 70%, respectively, and (b) the man included in Study II walked with very few breaks. Conclusion: Technology-based programs can be highly effective in helping persons with multiple disabilities improve their walking behavior. Implications for Rehabilitation A technology-aided program ensuring preferred stimulation for steps performed with adequate foot position might reduce toe walking in persons with multiple disabilities (MD). A technology-aided program ensuring preferred stimulation for walking might improve walking continuity in persons with MD. Technology-aided programs can be an important resource to improve walking behavior of persons with MD.

Promoting Physical Activity in People with Intellectual and Multiple Disabilities through a Basic Technology-Aided Program.

This study assessed a technology-aided program (monitoring responding, and ensuring preferred stimulation and encouragements) for promoting physical activity with 11 participants with severe/profound intellectual and multiple disabilities. Each participant was provided with an exercise device (e.g. a static bicycle and a stepper) and exposed to the program according to an ABAB design, in which A and B represented baseline and intervention phases, respectively. Data recording concerned (a) the participants’ responses with the exercise device (e.g. pedaling) during baseline and intervention phases and (b) their heart rates during the last intervention phase. The results showed that all participants had significant increases in responding with the exercise devices during the intervention phases. Heart-rate values during the intervention sessions indicated that the participants’ responding during those sessions mostly amounted to moderate-intensity physical activity, with potential benefits for their overall physical condition. Implications of the findings and questions for future research in the area were discussed.

People with multiple disabilities use assistive technology to perform complex activities at the appropriate time

Abstract Background: Persons with moderate/severe intellectual and multiple disabilities may have difficulties determining (a) the times of the day when to engage in specific activities and (b) the sequence of steps needed for those activities. Assistive technology might help them with both requirements. Methods: This study assessed an assistive technology package to (a) remind three adults with multiple (i.e. intellectual and sensory-motor) disabilities of the activities to carry out at the appropriate times of the day and (b) provide them pictorial instructions for the steps of those activities. It included a Galaxy S-3 mini smartphone (by Samsung) for delivering verbal reminders and a Microsoft Surface RT tablet for presenting pictorial instructions concerning the single steps of the activities programmed. The study was carried out according to a non-concurrent multiple baseline design across participants. Results: All three participants were successful in using both components of the technology package and managed to (a) independently start the activities at the scheduled times and (b) perform them with high levels of accuracy (i.e. with mean percentages of correct steps exceeding 90). Conclusion: A technology package may enable persons with multiple disabilities to perform complex activities at the appropriate times.

A Selective Overview of Microswitch-Based Programs for Promoting Adaptive Behaviors of Children with Developmental Disabilities

Assistive technology AT refers to any device, equipment and/or piece enabling children with developmental disabilities with self-determination and independence towards the outside world. Within this framework, microswitches represent electronic devices ensuring children with severe to profound developmental and/or multiple disabilities i.e. a combination of intellectual, sensorial and motor impairments to the independent access to preferred stimuli. This paper provides a selective overview of some illustrative examples available in the last fifteen years i.e. 2000-2015 of the empirical evidences published on this topic. Overall, 35 studies were reviewed. Results were widely positive, although some failures occurred. Educational, psychological and rehabilitative implications of the findings were discussed.