Fabrizio Stasolla

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.

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.

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.

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 Alzheimers 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.

Technological aids to promote basic developmental achievements by children with multiple disabilities: evaluation of two cases

Technological aids such as microswitches may be critical to foster learning and development in children with multiple disabilities. In study I, a child with minimal motor behavior was provided with a microswitch for chin movements to assess whether he could learn to use these movements to activate environmental stimuli. In study II, a child with dystonic (difficult-to-control) behavior was provided with microswitches for two motor responses and two vocal utterances. We wanted to assess whether he could use both types of responses effectively (varying within each pair, consistent with choice performance). The results were highly encouraging with both children. In study I, there was a significant increase in the child’s responding, suggesting learning and contingency awareness. In study II, there was a significant increase in responding as well as response variation that suggested choice behavior. The importance of microswitch devices in promoting new learning/developmental objectives and improving quality of life is discussed.

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.

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 girls 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.

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.

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.

A Microswitch Cluster to Enhance Arm-Lifting Responses without Dystonic Head Tilting by a Child with Multiple Disabilities

This study assessed whether a microswitch cluster 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 childs arm to monitor the lifting response, and the other at the childs 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.