A tablet-based program to enable people with intellectual and other disabilities to access leisure activities and video calls.

Purpose: This study evaluated a tablet-based program to help eight participants with moderate intellectual disability, sensory and/or motor impairments, and lack of expressive or expressive and receptive verbal skills to select and access leisure activities and video calls independently.Methods: The program relied on the use of a tablet (i.e., Samsung Galaxy Tab S2 LTE) with 8-inch screen, Android 6.0 Operating System, front camera, proximity sensor and multimedia player. The tablet was fitted with a SIM card and two specific applications, that is, WhatsApp Messenger for making video calls and MacroDroid for automating the tablet's functioning in accordance with the program conditions. The tablet presented pictures concerning leisure activities and preferred partners for video calls. The participant could select any activity or partner by touching (or nearing his or her hand to) the tablet's proximity sensor.Results: During the baseline (i.e., without the program), the participants failed to access leisure activities or video calls. During the post-intervention phase (i.e., with the program), they selected and accessed those activities and calls independently and spent between about 75% and 90% of the session time engaging with them.Conclusion: The tablet-based program can be highly beneficial for people like the participants of this study.Implications for rehabilitationA technology-aided program may enable persons with intellectual and other disabilities to independently access leisure activities and communication with distant partners.The program may involve the use of video calls to allow communication to participants with limited or no verbal skills.The program may be realized using a tablet (a) including Android 6.0 Operating System, proximity sensor, and multimedia player, and (b) fitted with a SIM card and applications such as WhatsApp Messenger and MacroDroid.The program may be easily adapted to the participants' characteristics in terms of activities available and partners to reach.

Experimental Examination and Social Validation of a Microswitch Intervention to Improve Choice-Making and Activity Engagement for Six Girls with Rett Syndrome.

Background: The use of assistive technology, specifically microswitches, with children with RTT has been shown to effectively moderate the impact of their disability on their quality of life- by facilitating access to meaningful leisure and other activities. Objectives: This study aimed to evaluate the effectiveness of a microswitch intervention on increased choice making, engagement in a targeted sorting activity, and indices of happiness, and decreased stereotypic behaviors for six girls with Rett syndrome. Targeted dependent variables were also assessed at six months post-intervention. Following the intervention study, 90 external raters completed a social validation procedure. Method: An ABABAB experimental sequence was implemented for each participant with a cross-over effect. A social validation assessment involving 90 external raters was carried out. Results: Data emphasized an improved performance for each participants involved (i.e., adaptive responses). Five participants showed a capacity of independent choice. One participant seemed to be closely linked to the position of the container. Social raters favorably endorsed the use of the program since they positively evaluated the use of the technology on all the dimensions investigated. Conclusion: A microswitch intervention may improve choice making and activity engagement for children with Rett syndrome. Further research is needed on the development of more sophisticated forms of individualized technological options to improve opportunities for enhanced engagement and choice-making for individuals with RTT.

Assistive technology for promoting adaptive skills of children with cerebral palsy: ten cases evaluation.

Objectives: To extend the use of assistive technology for promoting adaptive skills of children with cerebral palsy. To assess its effects on positive participation of ten participants involved. To carry out a social validation recruiting parents, physiotherapists and support teachers as external raters. Method: A multiple probe design was implemented for Studies I and II. Study I involved five participants exposed to a combined program aimed at enhancing choice process of preferred items and locomotion fluency. Study II involved five further children for a combined intervention finalized at ensuring them with literacy access and ambulation responses. Study III recruited 60 external raters for a social validation assessment. Results: All participants improved their performance, although differences among children occurred. Indices of positive participation increased as well. Social raters favorably scored the use of both technology and programs. Conclusion: Assistive technology-based programs were effective for promoting independence of children with cerebral palsy. Implications for Rehabilitation A basic form of assistive technology such as a microswitch-based program may be useful and helpful for supporting adaptive skills of children with cerebral palsy and different levels of functioning. The same program may improve the participants' indices of positive participation and constructive engagement with beneficial effects on their quality of life. The positive social rating provided by external experts sensitive to the matter may recommend a favorable acceptance and implementation of the program in daily settings.

An Upgraded Smartphone-Based Program for Leisure and Communication of People With Intellectual and Other Disabilities.

Background: People with intellectual disability and sensory or sensory-motor impairments may display serious problems in managing functional daily activities as well as leisure activities and communication with distant partners. Aim: The study assessed an upgraded smartphone-based program to foster independent leisure and communication activity of eight participants with mild to moderate intellectual disability, sensory or sensory-motor impairments, and limited speech skills. Method: The upgraded program was based on the use of (a) a Samsung Galaxy A3 smartphone with Android 6.0 Operating System, near-field communication, music and video player functions, and Macrodroid application, and (b) special radio frequency-code labels. Participants requested leisure and communication activities by placing mini objects or pictures representing those activities and containing frequency-code labels on the smartphone. The smartphone, via the Macrodroid application, read the labels (i.e., discriminated the participants' requests) and provided the participants with the activities requested. Results: During the baseline (i.e., in the absence of the program), the participants failed to request/access leisure and communication activities independently. During the post-intervention phase of the study (i.e., using the program), they succeeded in requesting/accessing those activities independently and spent about 70-90% of their session time busy with those activities. Conclusion: The upgraded smartphone-based program may be highly functional for people like the participants of this study.

Promoting physical activity in people with intellectual and multiple disabilities through a basic technology-aided program.

This study assessed a technology-aided program (monitoring responding, and ensuring preferred stimulation and encouragements) for promoting physical activity with 11 participants with severe/profound intellectual and multiple disabilities. Each participant was provided with an exercise device (e.g. a static bicycle and a stepper) and exposed to the program according to an ABAB design, in which A and B represented baseline and intervention phases, respectively. Data recording concerned (a) the participants' responses with the exercise device (e.g. pedaling) during baseline and intervention phases and (b) their heart rates during the last intervention phase. The results showed that all participants had significant increases in responding with the exercise devices during the intervention phases. Heart-rate values during the intervention sessions indicated that the participants' responding during those sessions mostly amounted to moderate-intensity physical activity, with potential benefits for their overall physical condition. Implications of the findings and questions for future research in the area were discussed.

Case series of technology-aided interventions to support leisure and communication in extensive disabilities.

Objectives: This study assessed a new technology-aided program to support independent leisure and communication engagement with people with intellectual and motor or sensory-motor disabilities. Methods: Six adults participated. The program relied on the use of a Samsung Galaxy Tab S2 LTE tablet with Android 6.0 Operating System, a NANO SIM card, and the WhatsApp Messenger and MacroDroid applications. The participants were presented with leisure and communication (i.e. text messaging) alternatives, and, based on their choices, with series of steps allowing them to access leisure events or send messages. Results: During baseline, the participants were unable to access leisure events or send messages. During intervention and post-intervention phases, they used the program successfully and spent large percentages of the session time independently engaged in leisure and messaging. Conclusions: A program based on readily available technology may be functional to support leisure and communication in people like the participants of this study.

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 microswitch-based program for promoting initial ambulation responses: An evaluation with two girls with multiple disabilities.

We assessed the use of a microswitch-based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid.

Assistive technology to promote occupation and reduce mouthing by three boys with fragile X syndrome.

OBJECTIVES: To extend the use of assistive technology (AT) for promoting a new adaptive response and to reduce hand mouthing, by three boys with fragile X syndrome. To monitor the effects of the intervention program on the positive mood. To carry out a three month follow-up phases. To conduct a social validation assessment involving 30 parents of children who presented multiple disabilities as raters. METHODS: The study was implemented according to an ABAB experimental design, where A represented baseline phases (technology available but inactive) and B represented intervention phases (the technology ensured 7 s of positive stimulation). RESULTS: All participants improved and consolidated their performance. Parents involved in the social validation assessment rated positively the use of such technology. CONCLUSION: AT-based program was useful, affordable, and effective for enhancing constructive engagement, self-determination, and for improving quality of life by children with fragile X syndrome and severe to profound developmental disabilities.

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.

Computer and microswitch-based programs to improve academic activities by six children with cerebral palsy.

This study was aimed at extending the use of assistive technology (i.e. microswitch such as a pressure sensor, interface and laptop) with a new setup, allowing six children with cerebral palsy and extensive motor disabilities to improve their academic activities during classroom. A second objective of the study was to assess a maintenance/generalization phase, occurring three months after the end of the intervention, at participants' homes, involving their parents. A third purpose of the study was to monitor the effects of the intervention program on the indices of positive participations (i.e. constructive engagement) of participants involved. Finally, a social validation procedure involving 36 support teachers as raters was conducted. The study was carried out according to a multiple probe design across behaviours followed by maintenance/generalization phase for each participant. That is, the two behaviours (i.e. choice among academic disciplines and literacy) were learned first singly, then combined together. Results showed an increasing of the performances for all participants involved during intervention phases. Furthermore, during maintenance phase participants consolidated their results. Moreover, positive participation augmented as well. Support teachers, involved in the social validation assessment, considered the combined intervention as more favourable with respect to those singly learned. Clinical, educational and practical implications of the findings are discussed.

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.

Assistive technology-based programs to promote communication and leisure activities by three children emerged from a minimal conscious state.

This study proposed the use of assistive technology (AT) to promote communication and leisure opportunities by three children with traumatic brain injury (TBI). Furthermore, it assessed the effects of such technology on the indices of positive participation and provided a social validation procedure. Three children emerged from a minimal conscious state and presenting extensive motor disabilities were involved. The intervention program allowed the participants to request and to choice preferred items independently and to perform literacy through a keyboard emulator. A multiple probe design across behaviors with post-intervention check was employed. Outcome measures were correct requests, understandable words, intervals with positive participation, and scores of social validation assessment. Request and choice behaviors and literacy improved significantly during intervention phases. During post-intervention check, all participants consolidated their performance. Moreover, indices of positive participation increased during intervention phases. Scores of social validation assessment showed that the combination of both behaviors was preferable to the same considered separately. AT program showed to be suitable for promoting constructive engagement and literacy behaviors by children with TBI. Future research is needed to generalize this data to a larger sample and to develop new technology for people with different levels of disabilities due to TBI.

Technological aids to support choice strategies by three girls with Rett syndrome.

This study was aimed at extending the use of assistive technology (i.e., photocells, interface and personal computer) to support choice strategies by three girls with Rett syndrome and severe to profound developmental disabilities. A second purpose of the study was to reduce stereotypic behaviors exhibited by the participants involved (i.e., body rocking, hand washing and hand mouthing). Finally, a third goal of the study was to monitor the effects of such program on the participants' indices of happiness. The study was carried out according to a multiple probe design across responses for each participant. Results showed that the three girls increased the adaptive responses and decreased the stereotyped behaviors during intervention phases compared to baseline. Moreover, during intervention phases, the indices of happiness augmented for each girl as well. Clinical, psychological and rehabilitative 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.

Microswitch-aided programs to support physical exercise or adequate ambulation in persons with multiple disabilities.

Three microswitch-aided programs were assessed in three single-case studies to enhance physical exercise or ambulation in participants with multiple disabilities. Study I was aimed at helping a woman who tended to have the head bending forward and the arms down to exercise a combination of appropriate head and arms movements. Study II was aimed at promoting ambulation continuity with a man who tended to have ambulation breaks. Study III was aimed at promoting ambulation with appropriate foot position in a girl who usually showed toe walking. The experimental designs of the studies consisted of a multiple probe across responses (Study I), an ABAB sequence (Study II), and an ABABB(1) sequence (Study III). The last phase of each study was followed by a post-intervention check. The microswitches monitored the target responses selected for the participants and triggered a computer system to provide preferred stimuli contingent on those responses during the intervention phases of the studies. Data showed that the programs were effective with each of the participants who learned to exercise head and arms movements, increased ambulation continuity, and acquired high levels of appropriate foot position during ambulation, respectively. The positive performance levels were retained during the post-intervention checks. The discussion focused on (a) the potential of technology-aided programs for persons with multiple disabilities and (b) the need of replication studies to extend the evidence available in the area.

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.

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 Alzheimer's 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.

Video prompting versus other instruction strategies for persons with Alzheimer's disease.

BACKGROUND/AIM: Two studies assessed the effectiveness of video prompting as a strategy to support persons with mild and moderate Alzheimer's disease in performing daily activities. METHODS: In study I, video prompting was compared to an existing strategy relying on verbal instructions. In study II, video prompting was compared to another existing strategy relying on static pictorial cues. Video prompting and the other strategies were counterbalanced across tasks and participants and compared within alternating treatments designs. RESULTS: Video prompting was effective in all participants. Similarly effective were the other 2 strategies, and only occasional differences between the strategies were reported. Two social validation assessments showed that university psychology students and graduates rated the patients' performance with video prompting more favorably than their performance with the other strategies. CONCLUSION: Video prompting may be considered a valuable alternative to the other strategies to support daily activities in persons with Alzheimer's disease.

A computer-aided telephone system to enable five persons with Alzheimer's disease to make phone calls independently.

This study extended the assessment of a computer-aided telephone system to enable five patients with a diagnosis of Alzheimer's disease to make phone calls independently. The patients were divided into two groups and exposed to intervention according to a non-concurrent multiple baseline design across groups. All patients started with baseline in which the technology was not available, and continued with intervention in which the technology was used. The technology involved a net-book computer provided with specific software, a global system for mobile communication modem (GSM), a microswitch, and lists of partners to call with related photos. All the patients learned to use the system and made phone calls independently to a variety of partners, such as family members, friends, and caregivers. A social validation assessment, in which care and health professionals working with persons with dementia were asked to rate the patients' performance with the technology and with the help of a caregiver, provided generally more positive scores for the technology-assisted performance. The positive implications of the findings for daily programs of patients with Alzheimer's disease are discussed.