The use of video self-modelling and feedback to teach cooking skills to individuals with traumatic brain injury: a pilot study.

OBJECTIVE: To evaluate the effectiveness of video self-modelling plus prompting and feedback to teach a cooking skill to people with traumatic brain injury (TBI) and to examine skill generalization to a novel food item. RESEARCH DESIGN: Multiple probe across participants. METHODS AND PROCEDURES: Four individuals with TBI received instruction in cooking. They watched videotapes of themselves cooking and practiced that skill while receiving prompts and feedback. Treatment effects were evaluated by comparing performance before, during and after training and at a 2 and 4 week follow-up. Additionally, cooking performance on a novel food item was examined. MAIN OUTCOMES AND RESULTS: Three of the four individuals achieved criterion performance within four training sessions. Those individuals also substantially maintained their skills 2 and 4 weeks following training and generalized their skills to a novel food item. CONCLUSIONS: Video self-modelling plus prompting and feedback appears to be an effective treatment for teaching simple cooking skills to individuals with TBI. Further research should examine whether the video alone is sufficient for skill acquisition and evaluate the effectiveness of video self-modelling to teach other skills.

Increasing self-determination: teaching people with mental retardation to evaluate residential options.

The community living preferences of 4 institutionalized adults with mild mental retardation were identified using photographs that depicted a variety of residential characteristics. Individuals then were taught to obtain information regarding their preferences during tours of community group homes, to report that information to their social workers, and to evaluate the homes based on the information obtained. A multiple baseline across participants design showed that all 4 participants substantially increased their skills at asking questions, reporting information, and evaluating homes. the results indicate that people with mental retardation can take an active role in major lifestyle decisions that others have typically made for them.

"Would I be able to ... "? Teaching clients to assess the availability of their community living life style preferences.

A three-phase program was developed to involve six institutionalized adults with mild mental retardation in their transition to community living. In Phase I, subjects were interviewed to determine their community living life style preferences and were found to be reliable and skillful in stating their preferences. In Phase II, the subjects' 10 strongest preferences were identified. In Phase III, they were taught to obtain preference availability information from group home representatives and report these findings to their social worker. A simultaneous replication design across two component skills, questioning and reporting, revealed that both increased after training and generalized to community group homes. The 5 subjects available for follow-up maintained their posttraining performance. Implications of these results in extending choice and decision-making technology were discussed.

An eight-year follow-up of three social skills training studies.

An 8-year follow-up of the maintenance of social skills training effects was conducted. Nine subjects from previously published studies that targeted general/social, social/vocational, and social/sexual skills were retested in role play or interview/simulation generalization assessments. The follow-up tests revealed that 5 subjects' correct responding was maintained well above their pretrained or baseline levels, and 3 responded above their posttest levels. Increases in an untargeted response, number of words per response, were maintained for most of the subjects whose percentage correct responding was maintained. The results suggest that some individuals will display enduring situation-specific social responding.

Long-term follow-up of echolalia and question answering.

A long-term follow-up of echolalia and correct question answering was conducted for 6 subjects from three previously published studies. The follow-up periods ranged from 26 to 57 months. In a training site follow-up, subjects were exposed to baseline/posttraining conditions in which the original trainer and/or a novel person(s) presented trained and untrained questions. Four subjects displayed echolalia below baseline levels, and another did so in some assessments. Overall, echolalia was lower than in baseline in 80.6% of the follow-ups. Five subjects displayed correct responding above baseline levels. No clear differences were noted in correct responding or echolalia between the trainer and novel-person presentations or between trained and untrained questions. In a follow-up in a natural environment conducted by a novel person, lower than baseline levels of echolalia were displayed by 3 subjects; 2 subjects displayed lower than baseline levels in some assessments. Two subjects consistently displayed correct responding above baseline, and 3 did so occasionally. Issues related to the study of maintenance are discussed.

A maintenance strategy for discontinuing aversive procedures: a 52-month follow-up of the treatment of aggression.

A strategy for systematically discontinuing aversive treatment components is illustrated with a 52-month follow-up of the treatment of severe aggression by an institutionalized, dually diagnosed deaf male. Phase 1 lasted 28 months and included: (a) contingent electric shock, (b) a high density positive reinforcement, (c) compliance training, (d) transfer of programmatic responsibility to others, and (e) a relaxation procedure. Phase 2 has lasted for 24 months and features (a) replacing shock with decreasing durations of nonexclusionary timeout and (b) naturally occurring reinforcers. Aggression has remained very low for over 4 years. The client is in an all day workshop, visits home frequently, and accompanies his parents on vacation. A social validity questionnaire revealed that he has become more sociable and less dangerous.

Cues-pause-point training and simultaneous communication to teach the use of signed labeling repertoires.

We taught two mentally retarded students who communicated by signing to answer questions with signed labels and evaluated the generalized effects of this training on their correct responding to untrained questions. The students received cues-pause-point training on one question set followed by generalization assessments on a different set in other settings. Periodic probes were conducted on two novel question sets in other settings to determine further the strength and spread of any generalization effects. A multiple baseline across-subjects design revealed that the students' incorrect signing was replaced with correct responding in the training and all generalization sets. These results replicate and extend previous research and suggest that cues-pause-point procedures can be useful in teaching students to use their manual signing repertoires.

Replacing maladaptive speech with verbal labeling responses: an analysis of generalized responding.

We taught three mentally handicapped students to answer questions with verbal labels and evaluated the generalized effects of this training on their maladaptive speech (e.g., echolalia) and correct responding to untrained questions. The students received cues-pause-point training on an initial question set followed by generalization assessments on a different set in another setting. Probes were conducted on novel questions in three other settings to determine the strength and spread of the generalization effect. A multiple baseline across subjects design revealed that maladaptive speech was replaced with correct labels (answers) to questions in the training and all generalization settings. These results replicate and extend previous research that suggested that cues-pause-point procedures may be useful in replacing maladaptive speech patterns by teaching students to use their verbal labeling repertoires.

Cues-pause-point language training: teaching echolalics functional use of their verbal labeling repertoires.

We evaluated the direct and generalized effects of cues-pause-point language training procedures on immediate echolalia and correct responding in two severely retarded females. Two experiments were conducted with each subject in which the overall goal was to encourage them to remain quiet before, during, and briefly after the presentation of questions and then to verbalize on the basis of environmental cues whose labels represented the correct responses. Multiple baseline designs across question/response pairs (Experiment I) or question/response pairs and settings (Experiment II) demonstrated that echolalia was rapidly replaced by correct responding on the trained stimuli. More importantly, there were clear improvements in subjects' responding to untrained stimuli. Results demonstrated that the cues-pause-point procedures can be effective in teaching severely retarded or echolalic individuals functional use of their verbal labeling repertoires.

Leisure-dance instruction for severely and profoundly retarded persons: teaching an intermediate community-living skill.

We evaluated an approach for teaching an intermediate community living skill via a leisure-dance activity to institutionalized severely and profoundly retarded persons. The targeted skill was considered as intermediate in contrast to a community living skill per se because it was based on successful performances of higher functioning, noninstitutionalized retarded persons as opposed to nonhandicapped individuals. Definitions for appropriate dancing were established and then validated through observations of the performance of retarded persons living in the local community. The dance skills were then taught to four participants through serial training in leg movements, arm movements, and coordinated leg and arm movements, plus follow-up trainer supervision. Generalization was also programmed by way of multiple trainers and training settings. Results during structured assessments showed that all four residents acquired the dance skills and that both serial training and follow-up supervision were necessary for skill acquisition. Generalized increases in appropriate dancing at dances attended by the participants and retarded persons from the community were also demonstrated. However, in most cases some active supervision by caregivers was needed to enhance the generalized improvements. Results are discussed in terms of the applicability of this approach for validating goals when training other community-related skills to low-functioning populations.

A rapid training procedure for teaching manual sign language skills to multidisciplinary institutional staff.

The benefits of teaching manual sign language skills to severely and profoundly mentally retarded persons are becoming well documented. However, if these individuals are to use manual signing for functional communication, then their daily caregivers must also be skilled in the use of signs. In this study, a program for teaching signing skills to institutional personnel was evaluated. The generality of the program's effectiveness was investigated in three studies involving different groups of staff: paraprofessional direct care staff, specialty habilitation persons, and nurses. Results showed that the training program, consisting of written and verbal instructions, modeling, practice, and verbal feedback, was effective in rapidly teaching signs to all participating staff members. Also, the acquired signing skills maintained over time, the program was well received by staff, and staff used the signs in their routine interactions with institutionalized residents. Results are discussed with respect to the need to insure that handicapped individuals have a manual signing community with which to use their signing skills and to important components of effective staff training programs.

A program for increasing manual signing by autistic and profoundly retarded youth within the daily environment.

A program was implemented to increase the manual signing of five profoundly retarded and four autistic youth within their daily environment. Each participant was nonvocal or minimally vocal. The program was based on modified incidental teaching strategies and was implemented by direct care personnel under supervision in an institutional setting. Specific components included rearranging the physical environment to prompt signing, altering routine staff-resident interactions to prompt, manually guide and/or reinforce signing; and conducting mini-training sessions. Additionally, staff modeled signs intermittently throughout the day. The program was sequentially implemented during two staff work shifts on each of two resident living modules. Observations conducted at four separate time periods during the day indicated that significant increases in signing occurred for all participating youth and that the increases generally maintained during follow-up checks at 5 and 17 weeks. Differential effects of the increased signing on frequency of vocalizations were noted across residents. A staff acceptability survey indicated favorable staff reports on the usefulness of signing to communicate with the youth. Results are discussed regarding the significance of manual signing for seriously developmentally disabled persons and the importance of ensuring that signing skills are used in the daily environment and not exclusively in formal training sessions. Also, areas for continued research are noted in terms of more refined analyses of client skills and subsequent progress in manual communication programs.

Involving institutional staff in the development and maintenance of sign language skills with profoundly retarded persons.

A program to involve institutional staff in developing manual sign language skills with profoundly retarded persons was evaluated. In Experiment 1, six direct care staff, with close supervision, taught a small repertoire of signs to six profoundly retarded residents who had not benefited from previous training in vocal language. Training was conducted in a group format using instructions, modeling, manual guidance, contingent reinforcers, and feedback. During training, all residents learned to identify pictures of objects with manual signs. Generalization observations during unstructured times on the residents' living unit indicated that staff used their signing skills with the residents in addition to their vocal interactions but the residents did not increase their signing or vocalizing. In Experiment 2, the residents' skills in signing with real objects on their living unit as opposed to pictures of objects were evaluated and provided with additional training where necessary. Results indicated that all participating residents learned to communicate with signing during structured interactions on their living unit, and the skills maintained during follow-up assessments ranging from 39 to 49 weeks. Results are discussed regarding the variable generalization effects noted as well as the general benefits and disadvantages of teaching manual signing skills to profoundly retarded persons.

Evaluating a supervision program for developing and maintaining therapeutic staff-resident interactions during institutional care routines.

This study evaluated a program to teach and maintain language training interactions between institutional staff and profoundly handicapped children during a routine care task. Following baseline observations of bath sessions, staff were sequentially taught in multiple baseline fashion to vocalize more during the bath, praise child vocalizations, imitate sounds, and provide sound prompts. Procedures included a brief in-service meeting followed by a series of supervisory prompts and feedback. Results indicated that staff acquired the interaction skills in the bath sessions and that the skills generalized to another direct care task, dressing. The number of days on which components of supervision were implemented decreased from 47% of all days during the experimental conditions to 19% of the days during a 19-week maintenance period with no decrease in staff behavior. The interactions were shown not to interfere with the quality of the direct care task nor to increase the amount of time necessary to complete it. Also, some increases were noted for child vocalization frequencies. The advantages of providing therapeutic interactions during care routines are discussed along with the need for staff management techniques with long-term maintenance value.