RESUMO
Following the declaration by the World Health Organization (WHO) of the Covid-19 pandemic on March 11, 2020, health organisations and staff have had to adapt and restructure services in order to respond to this global health emergency. Numerous containment strategies have been, and continue to be, introduced in this rapidly evolving and fluid situation with a significant shift towards virtual or remote patient assessment. The concept of virtual patient evaluation has previously been adopted across a range of medical and surgical specialities yielding safe and efficient pathways associated with good Patient Reported Outcome Measures (PROMs) and patient satisfaction rates. Whilst the idea of virtual patient review may be perceived as counterintuitive to the basic foundations and principles of face-to-face clinical practice, the current global pandemic, now more than ever, highlights the importance, need and benefits of this care model.
Assuntos
COVID-19/prevenção & controle , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Telemedicina/métodos , Assistência Ambulatorial , Humanos , Pandemias , SARS-CoV-2 , Telecomunicações , Interface Usuário-ComputadorRESUMO
Prior to the beginning of this study, the participant (an adolescent with postcoma multiple disabilities) had learned to use a forehead-skin response to access environmental stimuli. These learning data seemed to indicate a minimally conscious state (i.e., awareness of the link between response and stimuli) in spite of 1) a previous diagnosis of postcoma vegetative state; and 2) concomitant electrophysiological measurement showing no evidence of a passive P300 response and of mismatch negativity. The present study was an effort to extend the early learning investigation with two additional responses and related stimuli to broaden learning evidence and ascertain possible choice behavior. Results indicated that the participant learned the new responses and also provided evidence of choice behavior. These data were discussed in terms of the usefulness of the learning paradigm in the assessment and rehabilitation of persons with postcoma multiple disabilities and consciousness disorders.
Assuntos
Pessoas com Deficiência/reabilitação , Estado Vegetativo Persistente/reabilitação , Adolescente , Comportamento de Escolha , Auxiliares de Comunicação para Pessoas com Deficiência , Testa/fisiologia , Humanos , Masculino , Movimento/fisiologia , Estimulação FísicaRESUMO
Children with severe or profound intellectual and motor disabilities often present problems of balance and locomotion and spend much of their time sitting or lying, with negative consequences for their development and social image. This study provides a replication of recent (pilot) studies using a walker (support) device and microswitches with preferred stimuli to promote locomotion in two children with multiple disabilities. One child used an ABAB design; the other only an AB sequence. Both succeeded in increasing their frequencies of step responses during the B (intervention) phase(s). These findings support the positive evidence already available on the effectiveness of this intervention in motivating and promoting children's locomotion.
Assuntos
Deficiências do Desenvolvimento/reabilitação , Crianças com Deficiência/reabilitação , Eletrônica Médica/instrumentação , Locomoção/fisiologia , Tecnologia Assistiva/estatística & dados numéricos , Andadores/estatística & dados numéricos , Criança , Pré-Escolar , Auxiliares de Comunicação para Pessoas com Deficiência , Condicionamento Operante , Desenho de Equipamento , Feminino , Humanos , Masculino , Microcomputadores , Motivação , Transtornos das Habilidades Motoras/reabilitaçãoRESUMO
Microswitches are technical devices designed to enable persons with multiple disabilities to control environmental events, generally preferred stimuli such as music and lights, using simple/feasible responses. For example, a sound-detecting microswitch may allow a person to turn on brief periods of preferred stimulation through simple vocal responses. This study compared the accuracy of two versions of a sound-detecting microswitch, i.e., one using a throat microphone and the other both throat and airborne microphones, for a man with multiple disabilities. Analysis showed that the latter microswitch version radically reduced the false activations present with the former microswitch version. Thus, the latter version seemed to have a clear accuracy advantage over the former with important practical implications.
Assuntos
Métodos de Comunicação Total , Pessoas com Deficiência , Fala , Anormalidades Múltiplas , Adulto , Amplificadores Eletrônicos , Humanos , MasculinoRESUMO
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.
Assuntos
Adaptação Psicológica , Síndrome de Angelman/diagnóstico , Transtorno Autístico/diagnóstico , Transtornos do Comportamento Infantil/diagnóstico , Síndrome de Down/diagnóstico , Deficiência Intelectual/diagnóstico , Comportamento Social , Meio Social , Adolescente , Adulto , Síndrome de Angelman/psicologia , Transtorno Autístico/psicologia , Criança , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Síndrome de Down/psicologia , Feminino , Humanos , Lactente , Deficiência Intelectual/psicologia , Masculino , Determinação da Personalidade/estatística & dados numéricos , PsicometriaRESUMO
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 caregiver's 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.
Assuntos
Auxiliares de Comunicação para Pessoas com Deficiência/psicologia , Comunicação , Pessoas com Deficiência/reabilitação , Deficiência Intelectual/reabilitação , Quadriplegia/reabilitação , Comportamento Social , Adolescente , Atenção/fisiologia , Cuidadores , Criança , Crianças com Deficiência/psicologia , Crianças com Deficiência/reabilitação , Pessoas com Deficiência/psicologia , Feminino , Humanos , Deficiência Intelectual/psicologia , Masculino , Estimulação Física , Quadriplegia/psicologiaRESUMO
Two single-case studies were carried out using different procedural and technological approaches to enable two adolescents with multiple disabilities to choose among environmental stimuli. Study I focused on replicating a recently developed procedure, which relied on samples of the auditory stimuli available as cues for choice responses. Study II assessed a new procedural and technical setup relying on the use of pictorial representations of the stimuli available as cues for choice responses. The auditory samples and the pictorial representations were presented through computer systems. The participants' choice responses relied on microswitches connected to the computer systems. The data of Study I fully supported previous findings with the same procedural approach. The participant learned to choose preferred stimuli and bypass nonpreferred ones. The data of Study II showed that the participant learned to concentrate his choice. responses on a few stimuli, suggesting that these stimuli were actually preferred and that responding was purposeful. Implications of the results were discussed.
Assuntos
Comportamento de Escolha , Auxiliares de Comunicação para Pessoas com Deficiência , Crianças com Deficiência/psicologia , Deficiência Intelectual/psicologia , Microcomputadores , Meio Social , Estimulação Acústica , Adolescente , Atenção , Cegueira/psicologia , Cegueira/reabilitação , Paralisia Cerebral/psicologia , Paralisia Cerebral/reabilitação , Comorbidade , Sinais (Psicologia) , Crianças com Deficiência/reabilitação , Educação de Pessoa com Deficiência Intelectual , Humanos , Deficiência Intelectual/etiologia , Deficiência Intelectual/reabilitação , Masculino , Reconhecimento Visual de Modelos , Desempenho Psicomotor , Interface para o Reconhecimento da Fala , Terapia Assistida por ComputadorRESUMO
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.
Assuntos
Pessoas com Deficiência/reabilitação , Tecnologia Assistiva/estatística & dados numéricos , Televisão/estatística & dados numéricos , Atividades Cotidianas/psicologia , Adolescente , Atitude , Humanos , Atividades de Lazer , Masculino , Paralisia/reabilitação , Satisfação Pessoal , Desempenho Psicomotor/fisiologia , Reabilitação/educação , Tecnologia Assistiva/psicologia , Estudantes de Ciências da Saúde/psicologia , Inquéritos e QuestionáriosRESUMO
This study assessed the possibility of replacing head and hand responses (no longer feasible) with minimal movements within the microswitch-based program of an adolescent with deteriorating motor condition and multiple disabilities. The new movements, i.e., eye- and mouth-opening, were introduced individually and then combined through the simultaneous availability of the related microswitches. Data showed the participant acquired the new movements (responses) successfully and retained them at a 2-mo. postintervention check. Mood improvements, i.e., increases in indices of happiness, also occurred through the program. The conclusion was that a person with deteriorating motor conditions may be able to revitalize a microswitch-based occupational program and retain a constructive engagement if new, feasible responses are identified.
Assuntos
Pessoas com Deficiência/reabilitação , Pálpebras/fisiologia , Mãos/fisiologia , Cabeça/fisiologia , Boca/fisiologia , Movimento/fisiologia , Tecnologia Assistiva , Adolescente , Atitude Frente a Saúde , Auxiliares de Comunicação para Pessoas com Deficiência/estatística & dados numéricos , Humanos , Masculino , Transtornos das Habilidades Motoras/reabilitação , Terapia Ocupacional/instrumentação , Terapia Ocupacional/métodos , Satisfação Pessoal , Tecnologia Assistiva/psicologia , Tecnologia Assistiva/estatística & dados numéricosRESUMO
This study assessed small hand-closure movements as a potential response for microswitch activation with two participants with profound multiple disabilities of 5.2 and 20.6 yr. of age. The microswitch consisted of a two-membrane thin pad fixed to the palm of the hand and a control system. The outer membrane (the one facing the fingers) was a touch-sensitive layer; the inner membrane was activated if the participant applied a pressure of over 20 gm. The activation of either membrane triggered an electronic control system, which in turn activated one or more preferred stimuli for 6 sec. except in baseline phases. Each participant received an ABAB sequence, in which A represented baseline and B intervention phases, and a 1-mo. postintervention check. Analysis showed both participants increased their responding during the intervention phases and maintained that responding at the postintervention check. Implications of the findings are discussed.
Assuntos
Pessoas com Deficiência/reabilitação , Eletrônica Médica/instrumentação , Mãos/fisiologia , Transtornos das Habilidades Motoras/reabilitação , Tecnologia Assistiva/estatística & dados numéricos , Adulto , Pré-Escolar , Feminino , Força da Mão/fisiologia , Humanos , Movimento/fisiologia , Tato/fisiologiaRESUMO
This study assessed microswitch and computer technology to enable two participants with multiple disabilities, 32 and 19 years of age, to choose among environmental stimuli and request their repetition whenever they so desired. Within each session, 18 stimuli (12 preferred and 6 nonpreferred) were available. For each stimulus, a computer system provided a sample of 3 sec. duration. During the intervention, participants' vocal responding in relation to a stimulus sample activated a microswitch and a computer system turned on that stimulus for 15-30 sec. When participants did not vocally respond, the computer system paused briefly and then presented the next scheduled stimulus sample. When participants vocally responded at the end of a stimulus presentation, the stimulus was repeated. Intervention data showed that the participants learned to choose preferred stimuli and bypass nonpreferred ones as well as to request repetitions of the preferred stimuli. This performance was maintained at a 1-mo. postintervention check and transferred to sets of stimuli not used in the intervention. The implications of these results were discussed.
Assuntos
Comportamento de Escolha , Auxiliares de Comunicação para Pessoas com Deficiência , Pessoas com Deficiência/reabilitação , Microcomputadores , Pessoas com Deficiência Mental/reabilitação , Meio Social , Interface para o Reconhecimento da Fala , Adulto , Afeto , Aprendizagem por Associação , Pessoas com Deficiência/psicologia , Seguimentos , Humanos , Masculino , Motivação , Pessoas com Deficiência Mental/psicologia , Transferência de ExperiênciaRESUMO
This study evaluated the extent to which two microswitches used as interfaces would enable a man with multiple disabilities and limited motor behavior to operate an electric door opener at the entrance of the day center that he attended. Analysis showed the man (a) learned to use the two microswitches, (b) preferred the microswitch placed at his wheelchair's footrest (which also allowed more effective responding) over the microswitch placed at his wheelchair's armrest, and (c) maintained his positive performance at the 1- and 2-mo. postintervention checks. The results were discussed from a technical and practical standpoint and in terms of implications for the quality of life of persons with disabilities.
Assuntos
Pessoas com Deficiência , Deficiência Intelectual/complicações , Transtornos dos Movimentos/complicações , Tecnologia Assistiva , Adulto , Avaliação da Deficiência , Humanos , Masculino , Cadeiras de RodasRESUMO
This study assessed a writing program with word prediction, which completed the writing of a word and spoke it out only when there was certainty that such a word was the correct one. The assessment was carried out with a young man with multiple disabilities, who typically used a word-processing program without word prediction. The two programs were compared on the time required by the participant for writing general sentences, through a social validation assessment, and eventually a check on the participant's preference. Analysis showed the program with word prediction was significantly more effective in terms of the writing time, which was halved, and was deemed preferable by 40 raters (psychology students) involved in the social validation assessment and by the participant himself. Implications of the findings are discussed.
Assuntos
Pessoas com Deficiência , Desempenho Psicomotor , Percepção da Fala , Comportamento Verbal , Vocabulário , Adulto , Auxiliares de Comunicação para Pessoas com Deficiência , Humanos , Masculino , SoftwareRESUMO
BACKGROUND: Stimulation and microswitch-based programmes are considered main strategies to promote indices of happiness in students with multiple disabilities. However, only limited attempts have been made to assess the relative effects of the two programmes. This study conducted such an assessment with seven students with multiple disabilities. METHODS: The first four phases of the study served to: (1) provide the students with a systematic exposure to each of the programmes; and (2) measure the programmes' effects on indices of happiness by comparing them with baseline levels. The fifth phase served to compare the programmes with each other. RESULTS: The first four phases of the study showed that the microswitch-based programme produced a significant increase in indices of happiness for all seven students, and the stimulation programme produced a significant increase for six students. During the fifth phase of the study (i.e. when the two programmes were alternated), the microswitch-based programme promoted significantly higher indices of happiness than the stimulation programme for four of the seven students. CONCLUSIONS: Microswitch-based programmes might be deemed preferable to stimulation programmes because they can promote higher or comparable indices of happiness while promoting the acquisition of adaptive responses and self-determination.
Assuntos
Auxiliares de Comunicação para Pessoas com Deficiência/estatística & dados numéricos , Crianças com Deficiência/psicologia , Crianças com Deficiência/estatística & dados numéricos , Eletrônica/instrumentação , Eletrônica/estatística & dados numéricos , Felicidade , Estimulação Física/instrumentação , Criança , Feminino , Humanos , MasculinoRESUMO
This study examined a basic choice-analysis procedure to clarify choice between two responses and related stimuli by five persons with multiple disabilities ages 17.1 to 50.2 yr. The procedure was based on reversing the links between responses and stimuli to assess whether the stimuli accounted for differences in response levels. When this was not the case, the procedure added extra stimuli for the less preferred response to judge whether such an increase would compensate for the apparent disadvantage of that response, e.g., its higher physical cost. Analysis showed that the choice of three of the five participants seemed motivated by the stimuli following the responses. The choice of the other two persons seemed related to a preference for one of the responses which was partially or largely modified when extra stimuli were added.
Assuntos
Comportamento de Escolha , Auxiliares de Comunicação para Pessoas com Deficiência , Pessoas com Deficiência , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Comportamento de Escolha , Auxiliares de Comunicação para Pessoas com Deficiência , Crianças com Deficiência/reabilitação , Transtornos das Habilidades Motoras/reabilitação , Desempenho Psicomotor , Adolescente , Criança , Crianças com Deficiência/psicologia , Eletrônica , Feminino , Humanos , Movimento , PosturaRESUMO
PURPOSE: The two studies reported here served as replication and extension of preliminary research on the use of optic microswitches for eyelid responses with students with profound multiple disabilities. METHOD: In Study I, a young boy was taught to use the same combination of upward eyelid movement and optic microswitch utilized before. In Study II, an adolescent was taught to use a new combination of single blink response and optic microswitch. Study I included an ABAB sequence (in which A represented baseline and B intervention phases) and post-intervention checks. Study II included four phases assessing the effects of baseline, intervention, and non-contingent stimulation conditions. RESULTS: The results of Study I showed that the boy displayed high frequencies of the upward eyelid response during the intervention phases and post-intervention checks (suggesting learning effects). The results of Study II showed that the adolescent performed the single blink response at a significantly higher frequency during intervention as opposed to the other conditions (again suggesting learning effects). CONCLUSIONS: The results of Study I and Study II provide encouraging new evidence, with potentially important practical implications, about the applicability of eyelid responses and optic microswitches for students with profound multiple disabilities and minimal motor behaviour.
Assuntos
Piscadela/fisiologia , Eletrônica Médica/instrumentação , Pálpebras/inervação , Quadriplegia/reabilitação , Tecnologia Assistiva , Estudantes , Adolescente , Pré-Escolar , Pálpebras/fisiologia , Humanos , Masculino , Fatores de TempoRESUMO
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 boy's 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 boy's 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 boy's lack of responding led the computer system to present the next stimulus sample. RESULTS: Intervention data showed that the boy's 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.
Assuntos
Pessoas com Deficiência/reabilitação , Eletrônica Médica , Sobrancelhas , Sistemas Homem-Máquina , Desenvolvimento de Programas , Criança , Tomada de Decisões , Humanos , Masculino , Testes Psicológicos , Interface Usuário-ComputadorRESUMO
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.
Assuntos
Auxiliares de Comunicação para Pessoas com Deficiência , Crianças com Deficiência/reabilitação , Pálpebras/fisiologia , Transtornos das Habilidades Motoras/reabilitação , Tecnologia Assistiva , Criança , Meio Ambiente , Humanos , Masculino , Estatísticas não ParamétricasRESUMO
This study assessed whether an intervention approach relying on auditory prompting delivered automatically through a portable device was effective to reduce tongue protrusion in a woman with severe to profound mental retardation. The device involved (a) an optic sensor, i.e., a miniphotocell kept under the lower lip with medical tape, (b) a small signal transmission box, and (c) a Walkman for presenting the prompts. Initially, the automatic prompting condition was combined with occasional praise from a research assistant for having the tongue in the mouth. Analysis showed that the occurrence of tongue protrusion dropped from about 65% of the observation time during the initial baseline to less than 5% through the intervention. The study lasted 4.5 mo.