Doretta Oliva

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.

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.

Technology-based intervention options for post-coma persons with minimally conscious state and pervasive motor disabilities

Background: Intervention strategies, based on learning principles and assistive technology, were assessed with four post-coma persons with minimally conscious state and pervasive motor disabilities. Method: The first study taught a man to access environmental stimulation through a response-microswitch combination and another man to access environmental stimulation and request social contact through responses combined with a microswitch or a Voice Output Communication Aid (VOCA). The second study taught a man to access two forms of environmental stimulation via two response-microswitch combinations and another man to request two forms of contact via two response-VOCA combinations. Results: Data showed that all participants had significant increases in response levels (independent of whether the responses were combined with microswitch or VOCA devices) during the intervention phases of the studies. Conclusion: Intervention strategies based on learning principles and technology may be largely helpful for persons with minimally conscious state and pervasive motor disabilities.

Using multiple microswitches to promote different responses in children with multiple disabilities.

We examined the use of multiple microswitches to enhance different responses and environmental control with two boys with multiple disabilities. Four and three microswitches were used for the two boys, respectively. The microswitches were introduced individually. Once responding was established, two or three microswitches would be simultaneously available to allow the boys a wider range of response opportunities and a greater, more differentiated environmental input. Data showed that both boys learned to respond to the individual microswitches. The simultaneous availability of two or three microswitches promoted high levels of cumulative responding. Implications of the findings are discussed.

Two Boys with Multiple Disabilities Increasing Adaptive Responding and Curbing Dystonic/Spastic Behavior via a Microswitch-Based Program.

A recent study has shown that microswitch clusters (i.e., combinations of microswitches) and contingent stimulation could be used to increase adaptive responding and reduce dystonic/spastic behavior in two children with multiple disabilities [Lancioni, G. E., Singh, N. N., Oliva, D., Scalini, L., & Groeneweg, J. (2003). Microswitch clusters to enhance non-spastic response schemes with students with multiple disabilities. Disability and Rehabilitation, 25, 301-304]. The present study was an attempt to replicate the aforementioned study with two boys with multiple disabilities. The adaptive responses selected for the boys consisted of pushing an object with the hand or the back. The dystonic/spastic behavior consisted of body arching (i.e., pushing belly and stomach forward) and leg stretching for the two boys, respectively. Initially, the boys received preferred stimulation for all hand- and back-pushing responses. Subsequently, the stimulation followed only the responses that occurred free from the dystonic/spastic behavior. The results showed that both boys increased the frequency of adaptive responses, learned to perform these responses free from the dystonic/spastic behavior, and maintained this improved performance during a 2-month post-intervention check.

Three Persons with Multiple Disabilities Accessing Environmental Stimuli and Asking for Social Contact through Microswitch and VOCA Technology.

BACKGROUND Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregivers attention. METHODS Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three. RESULTS The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available. CONCLUSIONS Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.

An optic micro-switch for an eyelid response to foster environmental control in children with minimal motor behaviour.

This study assessed whether two children (11.9- and 9.7-years-old) with profound multiple disabilities and minimal motor behaviour could learn to control environmental stimulation using an eyelid response with a newly developed micro-switch. The response consisted of raising the eyelid markedly (i.e. by looking upward or opening the eyes widely). The micro-switch developed for this target response consisted of an electronically regulated optic sensor mounted on an eyeglasses’ frame. Data showed that the children learned the target eyelid response to activate the micro-switch and to increase their level of environmental stimulation. Responding was largely maintained at a 2-month post-intervention check. These results indicate that continued work in this area has positive implications for the rehabilitation of children with most serious disabilities.

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.

Microswitch clusters to support responding and appropriate posture of students with multiple disabilities: three case evaluations

Purpose: This study extended the evaluation of microswitch clusters to support responding and appropriate posture with three students with multiple disabilities. Method: Initially, a baseline level was established for the target response selected for each student. Then, Intervention I was implemented to increase the frequency of that response through the presentation of favourite stimuli. During Intervention II, the response was followed by favourite stimuli only if the microswitch cluster detected it in combination with appropriate posture. Post-intervention checks were carried out within 2 or 3 months from the end of Intervention II. Results and conclusions: All students showed an increase in the frequency of the target response during Intervention I and in the percentage of times the response occurred in combination with appropriate posture during Intervention II. These changes lasted over time. The importance of microswitch clusters to enhance the performance of students with multiple disabilities was underlined.

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.