Microswitch-based programs for persons with multiple disabilities: an overview of some recent developments

Persons with multiple disabilities are often unable to interact with their environment due to their limited response repertoire. Microswitch programs are designed to help them control environmental events, generally preferred stimulation, through simple (feasible) responses. To make microswitch programs a more widely usable and relevant resource for intervention with these persons, a number of new developments were pursued in recent years. This paper examines three of those developments as specifically addressed in our research activity, namely, (a) assessment of new, nontypical responses and matching microswitches, (b) fostering of multiple responses and exercise of choice, and (c) targeting of habilitative and clinical (therapeutic) objectives. The encouraging outcomes of these developments are reviewed in relation to their potentially wide implications for daily practice and the need of additional developments in the area.     

Access to environmental stimulation via eyelid responses for persons with acquired brain injury and multiple disabilities: a new microswitch arrangement

This study assessed a new microswitch arrangement for eyelid responses using an optic sensor placed above the cheekbone and a small sticker on the person's eyelid. This new arrangement, which was designed to avoid interference of the microswitch with the person's visual functioning, was tested on three adults with acquired brain injury and multiple (consciousness, communication, and motor) disabilities. The study was carried out according to a non-concurrent multiple baseline design across participants. Data showed the new microswitch arrangement was suitable for all three participants, who increased their responding during the intervention phase of the study when their responses allowed them to access preferred stimulation. Practical implications of the findings are discussed.     

Microswitch for vocalization responses: comparing single- versus dual-microphone arrangements for a man with multiple disabilities

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.     

Technological aids to promote basic developmental achievements by children with multiple disabilities: evaluation of two cases

Technological aids such as microswitches may be critical to foster learning and development in children with multiple disabilities. In study I, a child with minimal motor behavior was provided with a microswitch for chin movements to assess whether he could learn to use these movements to activate environmental stimuli. In study II, a child with dystonic (difficult-to-control) behavior was provided with microswitches for two motor responses and two vocal utterances. We wanted to assess whether he could use both types of responses effectively (varying within each pair, consistent with choice performance). The results were highly encouraging with both children. In study I, there was a significant increase in the childs responding, suggesting learning and contingency awareness. In study II, there was a significant increase in responding as well as response variation that suggested choice behavior. The importance of microswitch devices in promoting new learning/developmental objectives and improving quality of life is discussed.     

Increasing the happiness of individuals with profound multiple disabilities: replication and extension

A multielement design was used to compare the effects of three treatments on the happiness of 3 individuals with profound multiple disabilities. The conditions were typical programming using materials selected by staff, presentation of preferred materials plus social interaction, and social interaction alone with no materials present. Both the presentation of the preferred items with social interaction and social interaction alone resulted in higher happiness indicators than typical programming. The combination of preferred items and social interactions was somewhat superior to social interaction alone.     

Predicting the relative efficacy of three presentation methods for assessing preferences of persons with developmental disabilities

Choices were presented to 9 individuals with developmental disabilities using a two-choice format. Each pair of items, selected based on prior preference assessment, was presented to each participant in three conditions (actual items, pictures of the items, and spoken-name presentation) using a reversal design. The evaluation was conducted using food items, and was then repeated using nonfood items. The participants were also given a test to measure their skills on discrimination tasks ranging in difficulty from simple to conditional discriminations. The participants' abilities to make consistent choices with food and nonfood items were predicted, with 94% accuracy, by their discrimination skills. The findings suggest that presentation methods can affect the accuracy of a choice assessment, and that the systematic assessment of basic discrimination skills can be used to predict the effectiveness of different presentation methods in this population.     

A systematic evaluation of preferences identified through person-centered planning for people with profound multiple disabilities

Person-centered planning is becoming a popular means of designing supports for people with disabilities. However, very little research evaluating person-centered planning exists. We evaluated the degree to which items and activities reported to be preferred in person-centered plans represented accurate preferences based on how individuals responded when presented with the items and activities. Person-centered planning meetings were conducted with 4 individuals with profound multiple disabilities to develop preference maps and to identify leisure-related preferences. A sample of the reported preferences in the plans was then systematically assessed by observing each participant's approach and avoidance responses to the items and activities. Of the sampled items and activities reported to be preferred in the plans, 42% represented moderate preferences based on the latter assessment process and 33% represented strong preferences. With 2 participants, several preferences identified in the plans were nonpreferred items and activities based on the preference assessments, and some were frequently avoided. These results suggested that although person-centered plans may identify some accurate preferences for people with profound multiple disabilities, this approach should be used cautiously. Results also suggested that such plans should be supplemented with systematic preference assessments to ensure the accuracy of identified preferences. Future research areas focus on evaluating other aspects of person-centered planning.     

Embedded evaluation of preferences sampled from person-centered plans for people with profound multiple disabilities

We investigated a brief, embedded assessment for evaluating preferences sampled from person-centered plans. After developing person-centered plans for individuals with multiple disabilities, systematic assessments were conducted with preferences sampled from the plans. An assessment of sampled preferences was then embedded within the participants' daily routines. The two assessments identified similar preferences based on participant approach responses. Both assessments also indicated inconsistencies with reported preferences in the person-centered plans. Overall, results suggested the embedded assessment may be an alternative means of evaluating some preferences reported through person-centered planning.     

An enriched teaching program for reducing resistance and indices of unhappiness among individuals with profound multiple disabilities

We evaluated an enriched teaching program for reducing resistance and indices of unhappiness displayed by 3 individuals with profound multiple disabilities during teaching sessions. The program involved presentation of preferred activities before, during, and after each teaching session, discontinuation of identified nonpreferred activities, and a brief break and preferred activity following occurrence of resistance. Implementation of the enriched teaching program was accompanied by reductions in resistance and indices of unhappiness for each participant. Results also indicated no negative impact of the program on participant performance of the teaching steps or staff teaching proficiency. Staff questionnaire responses provided a degree of social validation for the observed changes in that staff reported the participants liked the enriched teaching program more than the traditional teaching process. Directions for future research discussed include identifying critical aspects of the overall program and the potential relation between teaching proficiency and the program's enrichment effectiveness.     

Multiple microswitches for persons with multiple disabilities: a basic procedure to examine the persons' choice behavior

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.     

Disciplinary sanctioning of students with intellectual disabilities: revisiting the status liability hypothesis

We examined the impact of disability status on disciplinary sanctioning of a student committing a minor versus severe behavioral infraction. We used the status liability hypothesis as a framework. This hypothesis suggests that individuals with a higher personal status receive sanctioning differentially based on the severity of offense. Specifically, individuals of high status are predicted to be sanctioned less severely than persons with lower status given a minor offense. The hypothesis also predicts that individuals accorded high status will receive more punitive sanctioning when the act of deviance from social norms is perceived as severe. Pre-service teachers were randomly assigned to judge the behavior of a student with or without an intellectual disability committing a behavioral offense. A student with an intellectual disability was seen as influenced by dispositional factors, regardless of the offense, while a student without a disability who committed a minor offense was seen as influenced by situational factors. The behavior of a student with an intellectual disability was judged as less severe, and the student was 50% less likely to incur an in-school suspension. When a student with an intellectual disability was sanctioned, the length of suspension was equal to that of a student without a disability.

Increasing the efficiency of instruction for a person with severe disabilities: The applicability of Fitts' law in predicting response time

The purpose of this study was to demonstrate the applicability of Fitts' law in predicting the response duration of instruction-specific head movements for a person with severe multiple disabilities. Fitts' law is a motoric algorithm that calculates an index of difficulty (ID) for responses in relation to the variables of stimulus width and stimulus amplitude. Four functional tasks from the learner's current continuing education plans were targeted: photocopying, using a paint well, model painting, and communication symbol sequencing. For each of the four tasks, two sets of indices were calculated by (1) holding constant stimulus width while varying amplitude, and (2) holding constant stimulus amplitude while varying width. Results showed that response duration varied as a function of ID variation.     

Error self-correction and spelling: improving the spelling accuracy of secondary students with disabilities in written expression

In order to improve the spelling performance of high school students with deficits in written expression, an error self-correction procedure was implemented. The participants were two tenth-grade students and one twelfth-grade student in a program for individuals with learning disabilities. Using an alternating treatments design, the effect of error self-correction was compared with a more traditional method of spelling practice. The intervention and follow-up phases were implemented over a 6-week period with maintenance checks conducted 4 and 8 weeks after the termination of instruction. Results indicated that the error self-correction procedure was superior to the traditional method of review during the intervention and follow-up phases, but some gains were lost during the maintenance phase.     

The psychometric properties of the center for epidemiological studies-depression scale (ces-d) when used with adults with physical disabilities

Abstract

Psychometric properties of the Center for Epidemiological Studies Depression Scale (CES-D) were examined in a sample of 790 adults with physical disabilities and compared to the responses obtained from non-disabled samples (Craig and Van Natta, 1976; Radloff, 1977). Findings suggested the CES-D is a valid measure of depressive symptoms among adults with physical disabilities. Scores on the CES-D scale were not elevated by somatic issues related to physical disability as evidenced by the lack of statistically significant differences in the persistence percentages reported by adults with physical disabilities and non-disabled adults for four of the seven items composing the somatic dimension of the CES-D. Moreover, the factor structure obtained via principal components analysis was highly similar to that obtained with non-disabled adults. Likewise, the Cronbach alpha value for the total score was within acceptable ranges and scores on the CES-D scale were moderately correlated with scores on a number of related but putatively distinct constructs.     

A comparison of multiple versus single examples of the correct stimulus on task acquisition and generalization by persons with developmental disabilities

In teaching discriminations to persons with retardation, we often presume we will improve acquisition and generalization if we use multiple examples of boththe correct and incorrect stimuli. Two experiments were conducted to test this hypothesis. In the first experiment, 7 persons with moderate retardation learned to discriminate between functional words under two conditions. In one condition, Multiple Example of S- Only,1 example of the correct stimulus (S+) and 10 examples of the incorrect stimulus (S-) were used during acquisition. In the other condition, Multiple Examples of S+ and S-,10 examples of the S+ and 10 examples of the S- were used. Results showed that the condition which presented only a single example of S+ was superior 16 times and inferior 4 times during acquisition, generalization, and maintenance. A second experiment was conducted to (a) replicate the methodology and procedures in Experiment 1 with different participants, (b) determine whether the results were replicable, and (c) obtain efficiency data. Results replicated the findings of the first experiment. The condition which presented only a single example of S+ was superior on measures of (a) trials to criterion, (b) percent correct during acquisition, and (c) minutes to criterion. On measures of generalization, the two conditions were relatively equal. Thus, the condition which presented only a single example of the correct stimulus was more efficient and was just as effective in generalization as the condition which presented multiple examples of both the S+ and S-. These surprising results were discussed in terms of stimulus control, why students performed just as well during generalization when only one example of the S+ was used, why acquisition was also poorer for this condition, and how future studies might address these points.     

Case study: Examining the relationship between self-initiations of an individual with disabilities and directive behavior of staff persons in a residential setting

This case study examines the relationship between self-initiations of an adult woman with severe disabilities and the directive behavior of staff persons in a community residential setting. Hypotheses generated from functional assessment procedures indicated that (a) Susan's low self-initiations were very likely related to high directive behavior of staff persons, and (b) infrequent problem behaviors during the morning routine were maintained by escape from repeated staff demands. An intervention was implemented to enable Susan to increase self-initiation in choice and sequence of activities and simultaneously decrease staff directives. Results and discussion focus on the need for a contextual approach for addressing problematic situations and an affirmation of the effectiveness of the positive behavioral support technology for increasing adaptive behaviors in individuals with severe disabilities.     

Assessing the quality of life in patients with multiple sclerosis in Kuwait: a cross sectional study

The main objective of this paper was to assess the level and the determinants of quality of life (QOL) amongst patients with multiple sclerosis (MS). A cross-sectional study was conducted among a convenience sample of 200 adult MS patients. Inclusion criteria were: MS diagnosis for at least one year, and aged 21+ years. However, exclusion criteria were: having other neurological diseases, serious cardiovascular, orthopedic or other disability precluding participation. Self-administered questionnaire employed MSQOL-54 with two outcomes: Physical Health Composite (PHC) and mental health composite (MHC). Satisfaction with Daily Occupation scale was adopted through face to face interviews. The median of PHC and MHC scores were 48.9/100, and 53.4/100 respectively. Multivariate analysis revealed that unemployment was a determinant of poor PHC, while low monthly income was a predictor of poor MHC. Additionally, low endurance and sensory problems were associated with poor PHC, and MHC, while motor problems were allied with only poor PHC. Patient’s satisfaction level with performing activities of daily living was positively associated with PHC and MHC. Assessment of QOL is suggested to be comprised in medical settings.     

A pilot study exploring the use of a telephone-assisted planning intervention to promote parental support for physical activity among children and youth with disabilities

Parent support is an important contributor to physical activity (PA) among children and youth with disabilities (CYD). Although many parents of CYD are motivated to provide parent PA support, CYD remain insufficiently active. The multi-process action control model has been applied to understand parent PA support and highlights behavioral regulation strategies such as action and coping planning as critical for translating intentions into behavior. Parents may struggle to create and carryout planning without support. There is no known research examining telephone support as a tool to promote planning and subsequent parent PA support behavior.MethodParents (43 mothers and 6 fathers) of CYD (child M_age = 12.53 years ± 5.53; 75% male; 38.6% developmental disability) completed a baseline questionnaire and were subsequently randomized to a telephone-assisted planning experimental group twice over four weeks (n = 23) or a control group who had access to planning tools but no telephone assistance (n = 26).ResultsNo significant main or interaction effects emerged for parent PA support behavior. However, a significant time × condition interaction was found for behavioral regulation strategies (i.e., action and coping planning and self-monitoring; F(1,44) = 5.05, p = 0.03) indicating a significant increase in the use of behavioral regulation strategies for parent PA support from baseline, for parents assigned to the telephone-assisted intervention.ConclusionThese findings suggest potential for planning support as a tool to enhance behavioral regulation strategies related to parent PA support among parents of CYD.     

Program report: “time-in”: A two-year project for the reduction of severe maladaptive behaviors in a center for persons with developmental disabilities

The results of a two-year project designed to organize a unit for 18 developmentally disabled clients with severe behavior disorders (primarily aggression) were presented. Providing tightly organized structure and focusing on appropriate resident behavior resulted in substantial gains. Noted changes included significant decreases in aggression, total number of target behaviors, required uses of restrictive procedures, and residents' injuries. Decreases were also noted in staff injuries and turnover. Subjectively, the unit became a better place to work and live. Difficulties encountered with developing, maintaining, and generalizing the project were discussed.