Angela Smaldone

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 childrens ambulation. Practical implications of the findings are discussed.

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.

Effects of microswitch-based programs on indices of happiness of students with multiple disabilities: a new research evaluation.

The effects of microswitch-based programs on indices of happiness were evaluated with 9 students who had profound multiple disabilities. Each student received an ABAB sequence in which A represented baseline phases and B, intervention phases. During the latter phases, microswitches were used to enable the students to control preferred environmental stimulation with simple/feasible responses, such as hand-pushing and foot-lifting. Results show that all students increased microswitch responding during the intervention phases. Seven of them also had significant increases in indices of happiness, whereas the other 2 did not. In an attempt to shed some light on the reasons underlying the different outcomes, we examined procedural and methodological aspects of the study.

Technology-assisted programs for promoting leisure or communication engagement in two persons with pervasive motor or multiple disabilities

Objective. To evaluate technology-assisted programs to help a man with pervasive motor disabilities and an adolescent with multiple disabilities manage the use of a radio and a special messaging system, respectively. Method. The technology for the man (Study I) involved a modified radio device, an electronic control unit, an amplified MP3 player with verbal questions about radio operations (changes), and an optic microswitch. This allowed the man to respond to the questions and carry out operations through minimal chin movement. The technology for the adolescent (Study II) involved a net-book computer fitted with specifically designed software, a global system for mobile communication (GSM) modem, and an optic microswitch. This allowed the adolescent to select the persons to whom he wanted to send messages and the messages to send them, and to listen to messages sent to him. Results. The data showed that both programs were effective, with the two participants learning to use the radio and the messaging system, respectively. Conclusion. Technology-assisted programs may represent useful tools for providing persons with pervasive and multiple disabilities leisure and communication opportunities.

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.

Helping a man with multiple disabilities increase object-contact responses and reduce hand stereotypy via a microswitch cluster program

Abstract Background People with profound and multiple disabilities often display aberrant behaviours (such as stereotypical movements) which can inhibit learning and lead to social stigmatisation. This study was designed to help a man with multiple disabilities increase his object-contact responses and reduce hand stereotypy (in this case, hand/wrist rotation). Method An A-B-A-B design with a 3-month post-intervention check was employed. At baseline, a combination of microswitches (or microswitch cluster) was used to monitor the mans object-contact responses and hand stereotypy. During the intervention phases and post-intervention check, the microswitch cluster was combined with preferred stimuli for object-contact responses occurring without hand stereotypy. The stimulation lasted for 8 seconds if the man remained free from hand stereotypy for that time, but was interrupted if the stereotypy appeared. Results The intervention showed an increase in object-contact responses occurring without hand stereotypy and a reduction in session time with hand stereotypy. These data were maintained at the 3-month post-intervention check. Conclusion Replication of these findings with other individuals would confirm the utility of this type of intervention for increasing constructive responding and reducing stereotyped behaviours.

Extending the Evaluation of Novel Microswitch Technology for Small Responses in Children With Profound Multiple Disabilities

This study extended the evaluation of microswitch technology (i.e., a position sensor and an optic device), recently introduced for chin and eyelid responses, with two new participants with profound multiple disabilities. The participants were girls of 12.5 and 4.0 years of age who did not possess any specific response that they could profitably use in their environment. The study was conducted according to an ABAB design with a 3-week postintervention check. The results showed that both participants increased their level of responding during the intervention phases and postintervention check compared to the baseline phases. This positive outcome was discussed in terms of (a) the apparent suitability of the technology and responses used in the study, (b) the beneficial implications for the participants, and (c) new developments in the area.

Promoting Adaptive Hand Responding and Reducing Face Hiding in a Woman with Profound Developmental Disabilities Using Microswitch Technology

We assessed the use of a microswitch cluster (i.e. a combination of two micro-switches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behaviour in a woman with profound developmental disabilities. The woman was initially taught an adaptive hand response that activated a pressure microswitch and produced preferred stimuli. Subsequently, her hand response led to preferred stimuli only if it occurred free from face hiding (i.e. aberrant behaviour detected through a mercury microswitch). The study also included a 3-month post-intervention and generalization check, and a social validation assessment. Data showed that the woman increased her adaptive responding, learned to perform this responding largely free from aberrant behaviour, and maintained and generalized the new performance across settings. Forty-five psychology students provided positive social validation of the womans new performance and the use of microswitch-cluster technology.

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.

Automatic prompting to reduce persistent tongue protrusion in a woman with severe to profound mental retardation.

This study assessed whether an intervention approach relying on auditory prompting delivered automatically through a portable device was effective to reduce tongue protrusion in a woman with severe to profound mental retardation. The device involved (a) an optic sensor, i.e., a miniphotocell kept under the lower lip with medical tape, (b) a small signal transmission box, and (c) a Walkman for presenting the prompts. Initially, the automatic prompting condition was combined with occasional praise from a research assistant for having the tongue in the mouth. Analysis showed that the occurrence of tongue protrusion dropped from about 65% of the observation time during the initial baseline to less than 5% through the intervention. The study lasted 4.5 mo.