Maria L. La Martire

Persons With Moderate Alzheimer's Disease Improve Activities and Mood via Instruction Technology

Background: Three studies assessed the (a) effectiveness of verbal instructions presented via technology in helping persons with moderate Alzheimers disease perform daily activities and (b) impact of activity engagement on mood. Methods: The 3 studies targeted coffee preparation with 2 women, use of make-up with 2 women, and use of make-up and tea preparation with 3 women. Intervention effects on activity performance were assessed through nonconcurrent multiple baseline designs across participants or multiple baseline designs across activities. The impact of activity on mood was assessed by recording indices of happiness during activity trials and parallel nonactivity periods. Results: Verbal instructions presented via technology were effective in helping all participants perform the target activities. The participants also showed mood improvement (ie, increases in indices of happiness) during the activity. Conclusion: These results suggest that the approach reported may be a useful strategy for helping persons with Alzheimers disease.

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 mild or moderate Alzheimer's disease managing daily activities via verbal instruction technology.

Four studies assessed the effectiveness of verbal instructions presented via technology in helping persons with mild or moderate Alzheimers disease perform daily activities. The first 2 studies were replication efforts concerning morning bathroom routine and table setting and included 4 and 2 participants, respectively. The third study targeted coffee preparation with 3 participants. The fourth study assessed maintenance and generalization of morning bathroom routine and dressing with 1 participant. Nonconcurrent multiple baseline designs served for the first 3 studies and a 5-month postintervention data collection for the fourth study. Verbal instructions for the activity steps presented via technology were effective in helping the participants of the first 3 studies reacquire basic daily activities and the participant of the fourth study retain the reacquired activities across time and settings. These results suggest that the approach reported may be a useful strategy for helping persons with Alzheimers disease.

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.

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.

Persons with multiple disabilities increase adaptive responding and control inadequate posture or behavior through programs based on microswitch-cluster technology.

Study I used typical microswitch-cluster programs to promote adaptive responding (i.e., object manipulation) and reduce inappropriate head or head-trunk forward leaning with a boy and a woman with multiple disabilities. Optic, tilt, and vibration microswitches were used to record their adaptive responses while optic and tilt microswitches monitored their posture. The study included an ABB(1)AB(1) sequence, in which A represented baseline phases, B represented an intervention phase in which adaptive responses were always followed by preferred stimulation, and B(1) represented intervention phases in which the adaptive responses led to preferred stimulation only if the inappropriate posture was absent. Study II assessed a non-typical, new microswitch-cluster program to promote two adaptive responses (i.e., mouth cleaning to reduce drooling effects and object assembling) with a man with multiple disabilities. Initially, the man received preferred stimulation for each cleaning response. Then, he received stimulation only if mouth cleaning was preceded by object assembling. The results of Study I showed that both participants had large increases in adaptive responding and a drastic reduction in inappropriate posture during the B(1) phases and a 2-week post-intervention check. The results of Study II showed that the man learned to control drooling effects through mouth cleaning and used object assembling to extend constructive engagement and interspace cleaning responses functionally. The practical implications of the findings are discussed.

Persons with multiple disabilities use forehead and smile responses to access or choose among technology-aided stimulation events.

A variety of technology-aided programs have been developed to help persons with congenital or acquired multiple disabilities access preferred stimuli or choose among stimulus options. The application of those programs may pose problems when the participants have very limited behavior repertoires and are unable to use conventional responses and microswitches. The present two studies assessed non-conventional response-microswitch solutions for three of those participants. Study I included two participants who were exposed to a program in which forehead skin movement was the response required to access preferred stimulation. The microswitch was an optic sensor combined with a small black sticker on the forehead. Study II included one participant who was exposed to a program in which a smile response was required to choose among stimuli. The microswitch for monitoring the smile was a new camera-based technology. The results of the two studies showed that the response-microswitch solutions were suitable for the participants and enabled them to perform successfully. Implications of the studies for people with limited motor behavior and issues for future research were discussed.

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.

Helping a man with multiple disabilities to use single vs repeated performance of simple motor schemes as different responses.

A man with multiple disabilities was taught to use single vs repeated performance of simple motor schemes as different responses. Specifically, single and double emissions of a finger movement served as two separate responses, which allowed direct access to different environmental stimuli via microswitch technology. Single and double emissions of a head movement served as two additional responses, which allowed interaction with two different caregivers who were called via voice output communication aids (VOCAs). The results showed that the man, who had pervasive motor impairment, acquired the four responses available and seemed to use them purposefully. The implications of this approach to increase the response options of persons with few controllable motor schemes were discussed.

Two Persons with Multiple Disabilities Use a Mouth-Drying Response to Reduce the Effects of Their Drooling.

These two studies involved a boy and a man with multiple disabilities, who were taught to use a mouth-drying response to reduce the effects of their drooling. Both studies relied on microswitch technology to monitor the drying response and follow it with positive stimulation (i.e., during intervention). In Study I, the boy performed the drying response via a special napkin. The microswitch technology consisted of touch/pressure sensors and a radio transmitter hidden inside the napkin. Drying responses led the boy to 8s of preferred stimulation. In Study II, the man performed the drying response via a handkerchief. The microswitch technology consisted of an optic sensor and a radio transmitter at the mans chest. Drying responses led the man to 8-10s of preferred stimulation. The stimulation time/conditions were subsequently modified to promote a reduction in the mans response frequency. The experimental design involved an ABAB sequence (Study I) or an ABABB(1)B(2) sequence (Study II), with the second B or the B(1)B(2) combination spreading over periods of about 3 months. The results indicated vast increases in drying responses and decreases in chin wetness during the intervention phases. The frequencies of the drying response remained consistent for the boy and stabilized at a lower level (i.e., in line with the manipulation of the stimulation conditions) for the man. Implications of the findings and limitations of the studies are discussed.