G. E. Lancioni

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.

Transferring AAC intervention to the home.

Purpose: To evaluate the acquisition of AAC skills during an initial clinical trial and assess subsequent transfer of the training to the home setting. Method: A 12-year-old male with autism was first seen in a clinical setting to establish the use of a voice-output communication device. After learning to use the device to request access to preferred objects in the clinical trial, the intervention was transferred to the home. Follow-up with the parent was conducted via e-mail and telephone. Videotapes were made of initial home-based sessions to enable evaluation of the participants progress. Results: The programme was successful in teaching the participant to use a portable AAC device to make requests during the clinical trial and then in two home-based activities. Conclusion: An initial clinical trial with follow-up support for parents may be an efficient method for beginning AAC intervention and transferring the training procedures to the home setting.

Behavioural flexibility in individuals with Angelman syndrome, Down syndrome, non-specific intellectual disability and Autism spectrum disorder

BACKGROUND Little is known about behavioural flexibility in children and adults with Angelman syndrome and whether people with this syndrome have more or less problems in being behaviourally flexible as compared with other people. METHOD Behavioural flexibility scores were assessed in 129 individuals with Angelman syndrome using 11 items from the Behavioural Flexibility Rating Scale-Revised (Green et al. 2007). Level of behavioural flexibility scores in individuals with Angelman syndrome (N = 129) was compared with that of people with non-specific intellectual disability (ID) (N = 90), Down syndrome (N = 398) and Autism spectrum disorder (N = 235). RESULTS Comparative analyses show that individuals with Angelman syndrome were more flexible than those with non-specific ID (P < 0.001) and those with Autism spectrum disorder (P < 0.01). There were no differences in behavioural flexibility scores between individuals with Angelman syndrome and those with Down syndrome (P = 0.94). CONCLUSION It is concluded that individuals with Angelman syndrome are comparatively flexible in their behaviour.

Enabling a person with multiple disabilities and minimal motor behaviour to control environmental stimulation with chin movements.

Purpose: To assess whether a young man with multiple disabilities and minimal motor behaviour would learn to control environmental stimulation using chin movements and a mechanical microswitch. Method: The study was carried out according to an ABAB design in which A represented baseline and B intervention phases. The chin movements controlled the stimulation only during the intervention phases. A 2-month post-intervention check was conducted. Results: The man increased the frequency of his chin movements, thus increasing the level of environmental stimulation, during the intervention phases. This performance was maintained at the post-intervention check. Conclusion: The use of chin movements is a practical strategy for enabling individuals with minimal motor movements to control environmental stimulation. Future research should examine whether similar types of movements may enable some individuals to control voice-output communication devices.

INDOOR TRAVEL AND SIMPLE TASKS AS PHYSICAL EXERCISE FOR PEOPLE WITH PROFOUND MULTIPLE DISABILITIES

2 to 4 30-min. periods of indoor travel and simple tasks were arranged daily as physical exercise for two women with profound mental retardation, deafness, and profound visual impairment. The questions were whether (a) the women could manage this fairly extensive exercise regimen (over about 9 and 4.5 mo.) with support technology and only minimal staff supervision and (b) the exercise could affect aspects of the womens physical condition. Data indicated that both women could successfully manage the exercise regimen with support technology, and the exercise seemed to have some beneficial effects on physical aspects such as bone metabolism and step width.

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.

A microswitch-based programme to enable a boy with multiple disabilities and minimal motor behaviour to choose among environmental stimuli.

Purpose. The present study assessed a microswitch-based programme designed to enable a nine-year-old boy with multiple disabilities and minimal motor behaviour to choose among environmental stimuli. Method. The programme relied on the boys eyebrow movements, a microswitch to detect such movements, and a computer system to handle sets of allegedly preferred and non-preferred stimuli. For each of the 30 stimuli available in every session, the computer system provided a sample/preview of 2 – 3 seconds. During intervention, the boys responding to a stimulus sample (i.e., moving the eyebrow and activating the microswitch) led the computer system to turn on that stimulus for 25 seconds. The boys lack of responding led the computer system to present the next stimulus sample. Results. Intervention data showed that the boys choice making (i.e., responding to a stimulus sample or avoiding to do so) was largely consistent with the alleged preference value of the stimuli, that is, he tended to choose the stimuli that were considered preferred and to bypass those considered non-preferred for him. The same performance was maintained during post-intervention checks, occurring 6 and 10 weeks after the end of the intervention, and over sets of stimuli not used during the intervention. Conclusions. The present microswitch-based programme may be considered useful to allow students with multiple disabilities an active choice (control) role in a stimulation-enriched environment.