Claudia De Pace

Persons with Multiple Disabilities Accessing Stimulation and Requesting Social Contact via Microswitch and VOCA Devices: New Research Evaluation and Social Validation

The first of these two studies assessed whether 11 participants with multiple disabilities of 5.3-18.2 (M=10.7) years of age would succeed in combining a microswitch for accessing preferred environmental stimuli and a Voice Output Communication Aid (VOCA) for requesting social contact. The second study conducted a social validation assessment of the aforementioned microswitch-VOCA combination. Data showed that all participants learned to use the microswitch and the VOCA. Moreover, the 10 participants, who received a 1-month post-intervention check, largely maintained their responding. The social validation assessment indicated that the raters (i.e., 110 university psychology students) favored the combination of microswitch and VOCA over the microswitch or the VOCA alone, and hypothetical combinations of microswitches or VOCAs.

Two persons with severe post-coma motor impairment and minimally conscious state use assistive technology to access stimulus events and social contact

Arranging and testing environmental/behavioral (i.e., non-medical) intervention programs for persons with severe post-coma motor impairment and minimally conscious state can be very challenging, and the experimental evidence available in the area is fairly limited [1–5]. Two environmental/behavioral intervention strategies, which might be used as a guide in this process, rely on general sensory stimulation and learning principles combined with assistive technology, respectively [1,2,5–9]. The first strategy rests on the notion that sensory stimulation may enhance recovery from brain injury, may reduce the risk of sensory deprivation that is highly likely in persons who have limited contact with the outside world, and may promote alertness while counteracting low arousal and withdrawal phenomena [5,10,11]. Sensory stimulation may occur through daily sessions involving the presentation of orientation cues and commands, general noises, familiar voices, radio and television clips, lights, vibrotactile inputs, or odors [5,12,13]. The second strategy relies on the notion that a learning setup and assistive technology might be used to help the person acquire/consolidate simple responses instrumental to access specific (preferred) environmental stimulation and positive human contact [14–17]. The expectation is to build an association between the responses and their positive effects (i.e., to enable the person to acquire some awareness of the link between his or her behavior and the immediate environment and thus enhance his or her level of consciousness and functional engagement) [15]. The latter strategy may be considered quite adequate in enriching the stimulation input, promoting an active role for the person, increasing his or her level of performance, and possibly developing his or her control of behavior and environmental events and ultimately his communication. The same strategy can also be easily adjusted (extended) over time to suit the person’s progress and emphasize his or her improving social image [15,18]. In spite of these positive aspects, the use of this strategy has been minimal and the need for new application efforts is clear [19,20]. This study was one such effort. It assessed a program based on the use of learning principles and assistive technology with two persons with a diagnosis of severe post-coma motor impairment and minimally conscious state. The program was intended to help the persons bring about brief periods of environmental stimulation through a microswitch and request contact with the caregiver through a voice output communication aid (VOCA). The microswitch and the VOCA were introduced in sequence and eventually were made simultaneously available so that the participants could decide (choose) about their use.

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.

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.

Technology-assisted programmes to promote leisure engagement in persons with acquired brain injury and profound multiple disabilities: two case studies

Objective. To evaluate technology-assisted programmes for enabling a woman and a man with brain injury and profound multiple disabilities to acquire leisure engagement. Method. The technology for the woman (Study I) involved a portable computer with mouse, a Clicker 4 software package, a touch/pressure microswitch, and an interface to connect the Clicker with the microswitch. This technology allowed the woman to choose with a simple hand response among four stimulus categories (e.g., watching a film and interacting with others), each of which included several alternatives. The technology for the man (Study II) involved a computer-based choice system that allowed him to select preferred songs through a microswitch-aided finger-movement response. Results. Data showed that the two participants learned to use the technology available and selected among the stimulus events thus reaching positive leisure engagement. Conclusion. Technology-assisted programmes may provide persons with acquired brain injury and multiple disabilities leisure engagement opportunities.

Nuove tecnologie a sostegno del percorso educativo nella disabilità cognitiva grave

Nel presente contributo verranno prese in considerazione le seguenti tecnologie: microswitch, VOCA, clusters di microswitch, programmi computerizzati per la scelta. I microswitch sono il mezzo piu efficace per consentire a persone con disabilita multiple di relazionarsi con l’ambiente e di controllare fonti di stimolazione interessante. I VOCA forniscono a persone con disabilita gravi e multiple (che non sono in grado di comunicare verbalmente) la possibilita di formulare richieste sia finalizzate a cose da ottenere che a persone con cui interagire. I clusters di microswitch sono una risorsa fondamentale per apprestare programmi diretti contemporaneamente al consolidamento di risposte adattive e alla riduzione di comportamenti- problema. I programmi computerizzati per la scelta sono soluzioni tecnologiche che possono avvalersi di stimoli uditivi o visivi che costituiscono possibili target di scelta per persone che non hanno possibilita di raggiungere direttamente tali stimoli nella realta. Per ciascuna di tali tecnologie verra fatto riferimento ad attivita di ricerca gia effettuate nell’ambito della nostra attivita scientifica.