Persons with intellectual and multiple disabilities activate via non-verbal responses a smartphone's Google Assistant to access preferred stimulation.

Objectives: The present study evaluated a new smartphone-based program to help 12 participants with intellectual disability plus visual and motor impairments to self-regulate their stimulation input (thus avoiding their dependence on staff) through simple non-verbal responses. Method: Nonconcurrent multiple baseline designs across participants were used to assess the effects of the program. The technology used for the program involved a Samsung J4 Plus smartphone with Android 9.0 operating system, two voice recording devices, smart-plugs, and a mini speaker. The smartphone was provided with a Google account and Internet connection, which allowed the participants to access Google Assistant and Google Play Music. The participants could make requests for two different types of stimulation (e.g. songs and familiar voices or noises) by activating via hand pressure the two voice recording devices. The verbal request messages emitted by the devices were recognized by the Google Assistant, which led the smartphone to deliver the related stimulation. Results: During the baseline sessions (without the support of the voice recording devices), the participants failed to access any stimulation. During the intervention and post-intervention phases (with the support of the voice recording devices), all participants managed to access the types of stimulation available independently. The mean frequency of responses (i.e. activations of both voice recording devices) per session ranged between about 8 and 14. Conclusion: The new smartphone-based program can be viewed as a useful resource to enable individuals like the participants of this study to access preferred stimulation independently.

Everyday Technology to Help People with Intellectual and Other Disabilities Access Stimulation via Functional Motor Responses and Improved Body Posture.

PURPOSE: This study assessed everyday technology to help eight participants with intellectual and sensory-motor disabilities access stimulation via functional arm/hand responses and improved body posture. METHODS: An ABABB1BB1 design was used for each participant, with A representing baseline phases, B intervention phases in which arm/hand responses led to a 12-s stimulation, and B1 intervention phases in which the stimulation for arm/hand responses was conditional on an improved/correct torso and head posture. The technology involved a Samsung Galaxy A10 smartphone fitted with Google Assistant and MacroDroid, a mini voice-recording device, and a portable mini voice amplifier. RESULTS: All participants had a large increase in arm/hand responses from the baseline periods to the B and B1 phases. They also had a large increase in correct posture from the B phases to the B1 phases. CONCLUSION: This technology-aided approach may be a helpful resource for people similar to the participants of this study.

Technology-Aided Spatial Cues, Instructions, and Preferred Stimulation for Supporting People With Intellectual and Visual Disabilities in Their Occupational Engagement and Mobility: Usability Study.

BACKGROUND: Persons with severe or profound intellectual disability and visual impairment tend to be passive and sedentary, and technology-aided intervention may be required to improve their condition without excessive demands on staff time. OBJECTIVE: This study aims to extend the assessment of technology-aided interventions for supporting functional occupational engagement and mobility in 7 people with intellectual disability and visual impairment and to use a technology system that is simpler and less expensive than those previously used. METHODS: The technology system involved a Samsung Galaxy A10, 4 Philips Hue indoor motion sensors, and 4 mini speakers. Within each session, the participants were to collect 18 objects (ie, one at a time) from 3 different areas (stations) located within a large room, bring each of the objects to a central desk, and put away each of those objects there. For each object, the participants received verbal (spatial) cues for guiding them to the area where the object was to be collected, a verbal instruction (ie, request) to take an object, verbal (spatial) cues for guiding them to the central desk, a verbal instruction to put away the object collected, and praise and preferred stimulation. RESULTS: During baseline, the frequency of responses completed correctly (objects collected and put away independently) was 0 or near 0. During the intervention phase (ie, with the support of the technology setup), the frequency increased for all participants, reaching a mean of almost 18 (out of 18 response opportunities) for 6 participants and about 13 for the remaining participant. The mean session duration ranged from 12 to 30 minutes. CONCLUSIONS: A program, such as the one used in this study, can be useful in promoting occupational engagement and mobility in persons with intellectual disability and visual impairment.

Promoting Functional Activity Engagement in People with Multiple Disabilities through the Use of Microswitch-Aided Programs.

BACKGROUND: People with severe/profound multiple (e.g., intellectual, motor, or sensory-motor) disabilities are frequently restricted to a situation of inactivity and dependence, which may be modified by promoting functional activity engagement through assistive technology. METHODS: This study assessed the possibility of promoting functional activity engagement via microswitch-aided programs with nine participants with multiple disabilities between 10 and 29 years of age. Functional activity consisted of constructive interaction with the immediate environment (e.g., reaching/touching or putting away objects) through the use of response schemes considered practical and beneficial for the participants' physical exercise and general condition. Microswitch-aided programs were used to monitor the participants' responses and to automatically provide stimulation opportunities contingent on those responses. RESULTS: All participants had a large/significant increase in their activity engagement (i.e., response frequencies) during the microswitch-aided programs, when compared to the baseline periods. These data, which are in line with previous findings in the area, indicate that the programs targeted activity and responses suitable for the participants and ensured contingent stimulation effective to motivate them. CONCLUSION: People with severe/profound multiple disabilities can engage in functional activity with the help of microswitch-aided programs.

A Technology-Aided Program to Support Basic Occupational Engagement and Mobility in Persons with Multiple Disabilities.

BACKGROUND: Persons with severe/profound intellectual and multiple disabilities tend to be passive and sedentary. Promoting their occupational engagement and mobility (i.e., indoor walking) can help to modify their condition and improve their environmental input, health, and social image. AIM: This study assessed whether a technology-aided program was suitable to (a) support independent occupation and mobility in eight participants with intellectual and sensory disabilities and (b) eventually increase the participants' heart rates to levels considered beneficial for them. METHOD: The program, which involved a computer system regulating the presentation of auditory or visual cues and the delivery of preferred stimulation, was introduced according to a non-concurrent multiple baseline design across participants. The auditory or visual cues guided the participants to collect objects from different desks and to transport them to a final destination (i.e., depositing them into a carton). Preferred stimulation was available to the participants for collecting and for depositing the objects. RESULTS: During the program, all participants had an increase in their independent responses of collecting objects and transporting them to the final destination. Their heart rates also increased to levels reflecting moderate-intensity physical exercise, potentially beneficial for their health. CONCLUSION: A program, such as that used in this study, can promote occupational engagement and mobility in persons with multiple disabilities.

Case Studies of Technology-aided Interventions to Promote Hand Reaching and Standing or Basic Ambulation in Persons with Multiple Disabilities.

Motor impairments such as lack of standing and/or independent ambulation are common among persons with multiple disabilities. These two studies assessed technology-aided programs for persons with those impairments. Specifically, Study I assessed a program to teach two non-ambulatory adults to hand reach a stimulation-linked object by standing up. Study II assessed a program to teach a child and a man to ambulate while holding a rail or following a corridor wall. Standing increased from below 15% to about or over 80% of the session duration in Study I. The participants of Study II managed to complete brief ambulation trials independent of guidance. These performance achievements were discussed in relation to the technology-aided programs employed in the studies and the programs' applicability in daily contexts.

Persons with multiple disabilities engage in stimulus choice and postural control with the support of a technology-aided program.

Technology-aided programs have been reported to help persons with disabilities develop adaptive responding and control problem behavior/posture. This study assessed one such program in which choice of stimulus events was used as adaptive responding for three adults with multiple disabilities. A computer system presented the participants stimulus samples. For each sample, they could perform a choice response (gaining access to the related stimulus whose length they could extend) or abstain from responding (making the system proceed to the next sample). Once choice responding had strengthened, the program also targeted the participants' problem posture (i.e., head and trunk forward bending). The stimulus exposure gained with a choice response was interrupted if the problem posture occurred. All three participants successfully (a) managed choice responses and access to preferred stimuli and (b) gained postural control (i.e., reducing the problem posture to very low levels). The practical implications of those results are discussed.

People with multiple disabilities learn to engage in occupation and work activities with the support of technology-aided programs.

These two studies were aimed at assessing technology-aided programs to help persons with multiple disabilities engage in basic occupation or work activities. Specifically, Study I focused on teaching two participants (an adolescent and an adult) with low vision or total blindness, severe/profound intellectual disabilities, and minimal object interaction to engage in constructive object-manipulation responses. The technology monitored their responses and followed them with brief stimulation periods automatically. Study II focused on teaching three adults with deafness, severe visual impairment, and profound intellectual disabilities to perform a complex activity, that is, to assemble a five-component water pipe. The technology regulated (a) light cues to guide the participants through the workstations containing single pipe components and the carton for completed pipes and (b) stimulation events. The results of both studies were positive. The participants of Study I showed consistent and independent engagement in object-manipulation responses. The participants of Study II showed consistent and independent pipe assembling performance. General implications of the two programs and the related technology packages for intervention with persons with multiple disabilities are discussed.

Further evaluation of a telephone technology for enabling persons with multiple disabilities and lack of speech to make phone contacts with socially relevant partners.

This study assessed whether a girl and a woman with multiple disabilities could (a) make phone contacts with relevant partners through a special telephone technology, and (b) enjoy their telephone-mediated communication with them. The technology involved a net-book computer, a global system for mobile communication modem (GSM), an optic microswitch, and specific software. The technology was programmed to present the names of the partners available for contact, and the participants could choose at each presentation sequence the one they wanted to contact with a simple microswitch response. Such response triggered the computer to place a phone call to that partner. Both participants (a) learned to use the technology quite rapidly to contact relevant partners and maintained the successful use of it over the intervention and post-intervention sessions, (b) showed high levels of indices of happiness during the phone calls as opposed to pre-baseline control sessions, and (c) showed preferences among the partners. Implications of the findings are discussed.

Two men with multiple disabilities carry out an assembly work activity with the support of a technology system.

OBJECTIVE: To assess whether two persons with multiple disabilities could learn a work activity (i.e., assembling trolley wheels) with the support of a technology system. METHOD: After an initial baseline, the study compared the effects of intervention sessions relying on the technology system (which called the participants to the different workstations and provided feedback and final stimulation) with the effects of intervention sessions carried out without technology. The two types of intervention sessions were conducted according to an alternating treatments design. Eventually, only intervention sessions relying on the technology system were used. RESULTS: Both participants managed to assemble wheels independently during intervention sessions relying on the technology system while they failed during sessions without the system. Their performance was strengthened during the final part of the study, in which only sessions with the system occurred. CONCLUSION: Technology may be critical in helping persons with multiple disabilities manage multi-step work activities.

Post-coma persons emerging from a minimally conscious state with multiple disabilities make technology-aided phone contacts with relevant partners.

Post-coma individuals emerging from a minimally conscious state with multiple disabilities may enjoy contact with relevant partners (e.g., family members and friends), but may not have easy access to them. These two single-case studies assessed whether those individuals could make contact with partners through computer-aided telephone technology and enjoy such contact. The technology involved a computer system with special software, a global system for mobile communication modem (GSM), and microswitch devices. In Study I, the computer system presented a 23-year-old man the names of the partners that he could contact, one at a time, automatically. Together with each partner's name, the system also presented the voice of the partner asking the man whether he wanted to call him or her. The man could (a) place a call to that partner by activating a camera-based microswitch through mouth movements or (b) bypass that partner and wait for the next one to be presented. In Study II, the system presented a 36-year-old man the partners' names only after he had activated his wobble microswitch with a hand movement. The man could place a call or bypass a partner as in Study I. The results showed that both men (a) were able to contact relevant partners through the technology, (b) seemed to enjoy their telephone-mediated communication contacts with the partners, and (c) showed preferences among the partners. Implications of the findings are discussed.

Three non-ambulatory adults with multiple disabilities exercise foot-leg movements through microswitch-aided programs.

This study assessed the use of microswitch-aided programs to help three non-ambulatory adults with multiple disabilities exercise foot-leg responses. Those responses served to activate a largely neglected part of the participants' body, with possibly positive physical implications (e.g., for blood circulation, swelling, and muscle strength). Intervention focused on the left and right foot-leg response, separately. Eventually, sessions with one response were alternated with sessions with the other response. Responses were monitored via microswitches and followed by 8s of preferred stimulation (e.g., music and vibrotactile stimulation), which was automatically delivered. The results showed that all three participants had high levels of foot-leg responses during the intervention phases and a 3-week post-intervention check. The participants also displayed expressions of positive involvement during those study periods (i.e., engaged in behaviors, such as music-related head movements, smiles, or touching the vibratory devices) that could be interpreted as forms of interest/pleasure and happiness. These results are in line with previous findings in this area and can be taken as an important confirmation of the strength and dependability of the approach in motivating non-ambulatory persons with multiple disabilities to engage in foot-leg movements. The practical implications of these findings are discussed.

Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies.

These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed.

Technology-aided programs to support exercise of adaptive head responses or leg-foot and hands responses in children with multiple disabilities.

OBJECTIVE: Assessing the effectiveness of technology-aided programs to help three children with multiple disabilities exercise adaptive head or leg-foot and hands responses independently. METHOD: The response selected for the two children included in Study I was head rotation (i.e. movements of at least 25 degrees to the left that could start from a full right position as well as from other positions). The responses selected for the child included in Study II involved forward movement of the left leg-foot and forward movement of his hand(s) to touch objects. Tilt or optic microswitches were used to monitor the responses and a computer system regulated the stimuli contingent on them. RESULTS: The responses targeted in the two studies showed large frequency increases during the intervention phases of the studies (i.e. when followed by stimulation). CONCLUSION: Technology-aided programs can be a useful resource to help children with multiple disabilities exercise relevant responses independently.

Persons with multiple disabilities exercise adaptive response schemes with the help of technology-based programs: three single-case studies.

The present three single-case studies assessed the effectiveness of technology-based programs to help three persons with multiple disabilities exercise adaptive response schemes independently. The response schemes included (a) left and right head movements for a man who kept his head increasingly static on his wheelchair's headrest (Study I), (b) left- and right-arm movements for a woman who tended to hold both arms/hands tight against her body (Study II), and (c) touching object cues on a computer screen for a girl who rarely used her residual vision for orienting/guiding her hand responses. The technology involved microswitches/sensors to detect the response schemes and a computer/control system to record their occurrences and activate preferred stimuli contingent on them. Results showed large increases in the response schemes targeted for each of the three participants during the intervention phases of the studies. The importance of using technology-based programs as tools for enabling persons with profound and multiple disabilities to practice relevant responses independently was discussed.

Two persons with multiple disabilities use orientation technology with auditory cues to manage simple indoor traveling.

This study was an effort to extend the evaluation of orientation technology for promoting independent indoor traveling in persons with multiple disabilities. Two participants (adults) were included, who were to travel to activity destinations within occupational settings. The orientation system involved (a) cueing sources only at the destinations (i.e., a single sound source per destination), (b) a newly developed electronic control device that allowed the participants to easily manage the activation of the sources at the destinations, and (c) the provision of approval or encouragement messages. Both participants were successful in using the system and performed their travels to the destinations fairly correctly and in relatively short amounts of time within (a) the occupational setting used for the intervention and (b) a similar occupational setting used for checking generalization effects. The findings are discussed in relation to the importance of independent indoor traveling and the impact of the new technology.

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.

Assisting persons with multiple disabilities to move through simple occupational activities with automatic prompting.

The present study assessed the possibility of assisting four persons with multiple disabilities to move through and perform simple occupational activities arranged within a room with the help of automatic prompting. The study involved two multiple probe designs across participants. The first multiple probe concerned the two participants with blindness or minimal vision and deafness, who received air blowing as a prompt. The second multiple probe concerned the two participants with blindness and typical hearing who received a voice calling as a prompt. Initially, all participants had baseline sessions. Then intervention started with the first participant of each dyad. When their performance was consolidated, new baseline and intervention occurred with the second participant of each dyad. Finally, all four participants were exposed to a second intervention phase, in which the number of activities per session doubled (i.e., from 8 to 16). Data showed that all four participants: (a) learned to move across and perform the activities available with the help of automatic prompting and (b) remained highly successful through the second intervention phase when the sessions were extended. Implications of the findings are discussed.

Promoting fluency of performance during morning dressing by two persons with multiple disabilities.

This study investigated the possibility of promoting fluency of performance, i.e., a performance independent of caregiver's guidance and without serious interruptions, during morning dressing in two adults with multiple disabilities. The intervention program relied on the use of assistive technology including optic and pressure sensors to monitor the participants' task responding and tape players to present preferred stimuli in relation to such responding, as well as messages of encouragement. Analysis showed that the intervention program was effective with both participants. In fact, they became capable of performing the dressing sequence with only occasional guidance from research assistants, and the time they required for dressing dropped significantly from baseline levels. Implications of the results are discussed.

Impact of favorite stimuli automatically delivered on step responses of persons with multiple disabilities during their use of walker devices.

Favorite stimuli were automatically delivered contingent on the performance of steps by two persons (a boy and a woman) with multiple disabilities during their use of support walker devices. The study lasted about 4 months and was carried out according to a multiple baseline design across participants. Recording concerned the participants' frequencies of steps and their indices of happiness during baseline and intervention sessions. Data showed that both participants had a significant increase in each of these two measures during the intervention phase. Implications of the findings and new research issues are discussed.