Teaching 'Yes' and 'No' responses to children with multiple disabilities through a program including microswitches linked to a vocal output device

The present study introduced two children (a boy and a girl of 9.2 and 12.3 yr. of age, respectively, with multiple disabilities) to an intervention program for establishing Yes and No responses in relation to preferred and nonpreferred stimuli and assessed the acquisition and generalization of those responses. The program involved the use of microswitches, which monitored the nonverbal Yes and No responses performed by the children and ensured that these responses produced the matching verbal utterances via a vocal output device. Analysis showed children acquired Yes and No responses in relation to the stimuli used for the intervention and, to a comparable degree, to the stimuli used for generalization checks as well. An interview of 30 educational staff of a center for persons with multiple disabilities indicated that they considered the presence of Yes and No verbal utterances preferable to the absence of such utterances, and thought that the utterances could be helpful for the children's response acquisition and would be useful and pleasing for staff and parents. General implications of the findings were discussed.     

Camera-Based Microswitch Technology to Monitor Mouth,Eyebrow, and Eyelid Responses of Children with Profound Multiple Disabilities

A camera-based microswitch technology was recently used to successfully monitor small eyelid and mouth responses of two adults with profound multiple disabilities (Lancioni et al., Res Dev Disab 31:1509–1514, 2010a). This technology, in contrast with the traditional optic microswitches used for those responses, did not require support frames on the participants’ face but only small color marks. The present study was aimed at extending the research evidence available on the aforementioned technology with the involvement of new participants and responses. The participants were three children with profound multiple disabilities. The responses selected for them consisted of mouth closing, eyebrow lifting, and repeated eyelid closures. The results showed that the new technology could be satisfactorily applied with all three children, across the three different responses. All children had large increases in responding during the intervention periods (i.e., when their responses were followed by preferred stimulation). The findings are discussed in relation to the possible impact of the new technology on programs for persons with multiple disabilities and minimal motor behavior.     

Enabling two adolescents with multiple disabilities to choose among environmental stimuli through different procedural and technological approaches

Two single-case studies were carried out using different procedural and technological approaches to enable two adolescents with multiple disabilities to choose among environmental stimuli. Study I focused on replicating a recently developed procedure, which relied on samples of the auditory stimuli available as cues for choice responses. Study II assessed a new procedural and technical setup relying on the use of pictorial representations of the stimuli available as cues for choice responses. The auditory samples and the pictorial representations were presented through computer systems. The participants' choice responses relied on microswitches connected to the computer systems. The data of Study I fully supported previous findings with the same procedural approach. The participant learned to choose preferred stimuli and bypass nonpreferred ones. The data of Study II showed that the participant learned to concentrate his choice. responses on a few stimuli, suggesting that these stimuli were actually preferred and that responding was purposeful. Implications of the results were discussed.     

A microswitch program including words and choice opportunities for students with multiple disabilities

Two students with multiple disabilities were provided with two or three request microswitches and one choice microswitch. Activation of a request microswitch triggered the verbal announcement of one of the stimulus events related to it. The student could choose such an event through the choice microswitch or bypass it. The request microswitches were introduced individually and made available simultaneously by the end of the intervention and the postintervention period. Analysis showed that both students learned to use the microswitches. Transfer of the microswitch program into the students' home was very successful with one student and presented some difficulties with the other. Implications of the findings and new possible developments were discussed.     

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.     

Promoting step responses of children with multiple disabilities through a walker device and microswitches with contingent stimuli

Children with severe or profound intellectual and motor disabilities often present problems of balance and locomotion and spend much of their time sitting or lying, with negative consequences for their development and social image. This study provides a replication of recent (pilot) studies using a walker (support) device and microswitches with preferred stimuli to promote locomotion in two children with multiple disabilities. One child used an ABAB design; the other only an AB sequence. Both succeeded in increasing their frequencies of step responses during the B (intervention) phase(s). These findings support the positive evidence already available on the effectiveness of this intervention in motivating and promoting children's locomotion.     

Technology-based intervention to help persons with minimally conscious state and pervasive motor disabilities perform environmentally relevant adaptive behavior

Persons with a diagnosis of minimally conscious state and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers' attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.     

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.     

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.     

Enabling a man with multiple disabilities and limited motor behavior to perform a functional task with help of microswitch technology

This study evaluated the extent to which two microswitches used as interfaces would enable a man with multiple disabilities and limited motor behavior to operate an electric door opener at the entrance of the day center that he attended. Analysis showed the man (a) learned to use the two microswitches, (b) preferred the microswitch placed at his wheelchair's footrest (which also allowed more effective responding) over the microswitch placed at his wheelchair's armrest, and (c) maintained his positive performance at the 1- and 2-mo. postintervention checks. The results were discussed from a technical and practical standpoint and in terms of implications for the quality of life of persons with disabilities.     

Promoting adaptive foot movements and reducing hand mouthing and eye poking in a boy with multiple disabilities through microswitch technology

This study assessed the viability of a microswitch cluster (i.e. a combination of microswitches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behavior in a boy with profound multiple disabilities. The boy was initially taught an adaptive foot-movement response that activated a motion microswitch and produced preferred stimuli. Subsequently, his foot response led to preferred stimuli only if it occurred in the absence of aberrant behavior (i.e. hand mouthing and eye poking which were detected through optic microswitches). Moreover, full access to the stimuli required that the boy refrain from aberrant behavior during their presentation as well. The study also included a 3-month post-intervention check and a social validation assessment. Data showed that the boy (i) increased his adaptive responding, (ii) learned to perform this responding largely free from aberrant behavior and refrained from that behavior for most of the session time, and (iii) maintained this performance at the post-intervention check. The social validation ratings of 40 teachers and teacher assistants significantly favored the last intervention period (in which aberrant behavior was reduced) over the initial period.     

Long-term response-stimulus associations can influence distractor-response bindings

Strong associations between target stimuli and responses usually facilitate fast and effortless reactions. The present study investigated whether long-term associations between distractor stimuli and responses modulate behavior. In particular, distractor stimuli can affect behavior due to distractor-based stimulus-response retrieval, a phenomenon called distractor-response binding: An ignored stimulus becomes temporarily associated with a response and retrieves it at stimulus repetition. In a flanker task, participants ignored left and right pointing arrows and responded to a target letter either with left and right (strongly associated) responses or with upper and lower (weakly associated) responses. Binding effects were modulated in dependence of the long-term association strength between distractors and responses. If the association was strong (arrows pointing left and right with left and right responses), binding effects emerged but only in case of compatible responses. If the long-term association between distractors and responses was weak (arrows pointing left and right with upper and lower responses), binding was weaker and not modulated by compatibility. In contrast, sequential compatibility effects were not modulated by association strength between distractor and response. The results indicate that existing long-term associations between stimuli responses may modulate the impact of an ignored stimulus on action control.     

Effector-related sequence learning in a bimanual-bisequential serial reaction time task

In a bimanual-bisequential version of the serial reaction time (SRT) task participants performed two uncorrelated key-press sequences simultaneously, one with fingers of the left hand and the other with fingers of the right hand. Participants responded to location-based imperative stimuli. When two such stimuli appeared in each trial, the results suggest independent learning of the two sequences and the occurrence of intermanual transfer. Following extended practice in Experiment 2, transfer of acquired sequence knowledge was not complete. Also in Experiment 2, when only one stimulus appeared in each trial specifying the responses for both hands so that there was no basis for separate stimulus-stimulus or separate response-effect learning, independent sequence learning was again evident, but there was no intermanual transfer at all. These findings suggest the existence of two mechanisms of sequence learning, one hand-related stimulus-based and the other motor-based, with only the former allowing for intermanual transfer.     

Microswitch programs for persons with multiple disabilities: an overview of the responses adopted for microswitch activation

Background: To introduce a person with multiple disabilities to a microswitch-aided program, one has to select a plausible response(s), that is, a response(s) that can be performed reliably and without excessive effort by the person and can successfully activate the microswitch(es) available (producing preferred stimuli). This paper provides an overview of the responses adopted for microswitch activation in research studies during the last 20 years. Method: Computerized and manual searches were carried out to identify the studies published between 1986 and 2005. Forty-eight research studies were identified. They concerned the use of (1) a single (typical) response, (2) a single (non-typical) response, (3) multiple (typical and non-typical) responses, and (4) multiple (vocal) responses. Results and discussion: The results showed that 151 of the 190 participants involved in the studies had a positive outcome (i.e., clear increases in their responding, which suggested that they had learned the association between responding and consequent preferred stimuli). Failures were largely concentrated in the first group of studies. The discussion focused on (a) the importance of selecting plausible responses for increasing the chances of success, (b) the need of non-typical responses for persons with minimal motor behavior, (c) implications of programs with multiple responses on engagement and choice, and (d) relevance of using vocal utterances. Some suggestions for future research concerning these points were also examined.     

The impact of high- and low-preference stimuli on vocational and academic performances of youths with severe disabilities

Pictorial and tangible paired-stimulus preference assessments were compared with 4 adolescents with developmental disabilities. In the tangible assessment, two stimuli were placed in front of the participant on each trial; in the pictorial assessment, two line drawings were placed in front of the participant on each trial. Approach responses were recorded for each assessment. The assessments generated similar preference hierarchies for all participants. Reinforcer assessments confirmed that response rates were higher when access to high-preference items was available than when low-preference items were available. Implications for assessing preferences and selecting items to be used in training programs are discussed.     

Eye- and mouth-opening movements replacing head and hand responses in a microswitch program for an adolescent with deteriorating motor condition

This study assessed the possibility of replacing head and hand responses (no longer feasible) with minimal movements within the microswitch-based program of an adolescent with deteriorating motor condition and multiple disabilities. The new movements, i.e., eye- and mouth-opening, were introduced individually and then combined through the simultaneous availability of the related microswitches. Data showed the participant acquired the new movements (responses) successfully and retained them at a 2-mo. postintervention check. Mood improvements, i.e., increases in indices of happiness, also occurred through the program. The conclusion was that a person with deteriorating motor conditions may be able to revitalize a microswitch-based occupational program and retain a constructive engagement if new, feasible responses are identified.     

Technological Resources to Support Adaptive Responding with Persons with Multiple Disabilities

This study assessed technological resources for supporting adaptive responses in 2 men with profound multiple disabilities. The technological resources (an electronic control device connected to optic sensors and pleasant stimuli) ensured the activation of those stimuli contingent on adaptive responses. The responses consisted of putting various objects in a container fitted to a desk. Data showed that both participants reached satisfactory levels of adaptive responses in the intervention and generalization settings. Procedural issues, practical implications of the findings and measures for promoting response maintenance were discussed.     

Influences of response position and hand posture on the orthogonal Simon effect

When lateralized responses are made to the locations of vertically arrayed stimuli, two types of mapping effect have been reported: an overall up–right/down–left advantage and mapping preferences that vary with response position. According to Cho and Proctor's (2003) multiple asymmetric codes account, these orthogonal stimulus–response compatibility effects are due to the correspondence of stimulus polarity and response polarity, as determined by the positions relative to multiple frames of reference. The present study examined these two types of orthogonal compatibility for situations in which participants made left–right responses to the colours of a vertically arrayed stimulus set, and stimulus location was irrelevant. Although a significant orthogonal Simon effect was not evident when responding at a centred, neutral response position, the effect was modulated by response eccentricity (Experiment 2) and hand posture (Experiment 3). These effects are qualitatively similar to those obtained when stimulus location is task relevant. The results imply that, as Proctor and Cho's (2006) polarity correspondence principle suggests, the stimulus polarity code activates the response code of corresponding polarity even when stimulus location is irrelevant to the task.     

Enabling persons with multiple disabilities to choose among environmental stimuli and request stimulus repetitions through microswitch and computer technology

This study assessed microswitch and computer technology to enable two participants with multiple disabilities, 32 and 19 years of age, to choose among environmental stimuli and request their repetition whenever they so desired. Within each session, 18 stimuli (12 preferred and 6 nonpreferred) were available. For each stimulus, a computer system provided a sample of 3 sec. duration. During the intervention, participants' vocal responding in relation to a stimulus sample activated a microswitch and a computer system turned on that stimulus for 15-30 sec. When participants did not vocally respond, the computer system paused briefly and then presented the next scheduled stimulus sample. When participants vocally responded at the end of a stimulus presentation, the stimulus was repeated. Intervention data showed that the participants learned to choose preferred stimuli and bypass nonpreferred ones as well as to request repetitions of the preferred stimuli. This performance was maintained at a 1-mo. postintervention check and transferred to sets of stimuli not used in the intervention. The implications of these results were discussed.     

How motor practice shapes memory: retrieval but not extra study can cause forgetting

We investigated the retrieval specificity of retrieval-induced forgetting (RIF) of motor sequences. In two experiments, participants learned sequential finger movements, each consisting of the movement of two fingers of either the left or the right hand. In the learning phase, these motor sequences were graphically presented and were to be learned as responses to simultaneously presented letter stimuli. Subsequently, participants selectively practiced half the items of one hand. A final recall test then assessed memory for all initially learned items. We contrasted different kinds of selective practice with each other. Whereas retrieval practice required retrieving motor sequences in response to letter stimuli from the learning phase, extra study was an extension of the learning phase, that is, participants performed motor sequences in response to the same animation graphic display as in the learning phase again accompanied by the letter stimulus. All practice conditions strengthened the practiced items, but only retrieval practice resulted in RIF. Thus, the strengthening of items through practice did not suffice to induce forgetting of related motor sequences. Retrieval was a necessary component for practice to shape memory for body movements by impairing the subsequent recall of motor sequences that were related to the practiced motor sequences.