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.     

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.     

Reducing indices of unhappiness among individuals with profound multiple disabilities during therapeutic exercise routines.

A program was developed to reduce indices of unhappiness that accompanied therapeutic exercise routines among people with profound multiple disabilities. Indices of unhappiness were recorded, using an observation system that had been validated through previous research involving happiness-related variables, while support personnel conducted exercises with 3 participants. A multicomponent program was then implemented that involved presenting highly preferred stimuli before, during, and after each exercise session. Results indicated that the program was accompanied by reduced indices of unhappiness for each participant relative to the traditional method of conducting the exercises, although changes in the preferred stimuli used with 1 participant were required before consistent reductions occurred. Results are discussed regarding the importance of reducing unhappiness indices as a means of enhancing aspects of the daily quality of life for people with profound multiple disabilities. Areas for future research are also discussed, focusing on expanding the unhappiness-reduction procedures to other routine events that may occasion indices of unhappiness.     

Adapting a grid into a microswitch to suit simple hand movements of a child with profound multiple disabilities

We adapted a grid into a microswitch for the hand movements of a girl with profound multiple disabilities who lay on her back. The grid, suspended above the girl's face, was equipped with two mercury devices, i.e., small sealed ampoules containing a mercury drop and ending with conductive leads. A lateral or forward movement of the grid would make the mercury drop of at least one device slide to the conductive leads and activate the device. During the intervention, activations of the devices, i.e., microswitch activations, produced the occurrence of favorite stimuli. Analysis showed that the girl increased the frequency of hand movements and microswitch activations during the intervention phases compared to the baseline phases (when the favorite stimuli were not available). The increase was retained at a 1-mo. postintervention check.     

Empowering people with physical disabilities through advocacy skills training

Members of an advocacy organization for people with physical disabilities were trained to identify and report issues at group meetings. In addition, two consecutive chairpersons were trained to conduct action-oriented meetings. Measures of group members' activities outside meetings and related outcomes on identified issues were also collected. Results indicated increases in the number of disability-related issues reported by trained members and consistent improvements in chairperson performance following training. Retrospective interviews and permanent records showed that advocacy activities, as well as the outcomes of members' actions, increased after training. These findings and their implications for the empowerment of people with disabilities are 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.     

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.     

Assessing a microswitch-based stimulation procedure for eye-blinking responses in a young woman with profound multiple disabilities

We applied a new microswitch-based stimulation procedure for eye-blinking responses with a young woman with profound multiple disabilities, and compared effects of this procedure on the eye-blinking responses and smiling with the effects of a caregiver-based stimulation condition. Analysis showed that the microswitch-based stimulation procedure, with stimulation occurring contingent on eye-blinking responses, increased the frequencies of these responses significantly above the levels recorded in baseline and caregiver-based stimulation conditions. No changes in smiling frequencies occurred. Implications of the findings in terms of alertness, learning, and quality of life are discussed.     

A job-seeking self-efficacy scale for people with physical disabilities: preliminary development and psychometric testing

People with disabilities are at an increased risk of unemployment. The role of interventions aiming to enhance the employment prospects of people with disabilities is receiving increased attention. However, evaluation is hampered by the paucity of measures specific to the needs of the target population. The purpose of the present study was to develop and conduct preliminary testing of the psychometric properties of a job-seeking self-efficacy (JSS) scale that reflected the experiences of people with physical disabilities. Job-seeking self-efficacy was defined as perceived ability to perform the skills involved in seeking employment that are salient to people with disabilities. Scale development and testing involved four studies and resulted in the 12-item JSS scale and six-item managing disability at interview (MDI) component, both of which were unidimensional and had high internal consistency. In addition, there was evidence of construct and concurrent validity. Greater jobseeking self-efficacy and perceived ability to manage disability at interview were associated with more positive psychological well-being. Only the MDI component was associated with physical functioning: lower perceived ability to manage disability at interview was associated with greater impairment of physical functioning. The pattern of associations supported the rationale for a separate component reflecting the need to resolve practical issues linked to access and availability of facilities before participation in the interview procedure per se .     

Poverty and people with intellectual disabilities

Epidemiological studies have consistently reported a significant association between poverty and the prevalence of intellectual disabilities. The available evidence suggests that this association reflects two distinct processes. First, poverty causes intellectual disabilities, an effect mediated through the association between poverty and exposure to a range of environmental and psychosocial hazards. Second, families supporting a child with intellectual disabilities and adults with intellectual disabilities are at increased risk of experiencing poverty due to the financial and social impact of caring and the exclusion of people with intellectual disabilities from the workforce. It is likely that the association between poverty and intellectual disabilities accounts in part for the health and social inequalities experienced by people with intellectual disabilities and their families. Implications for policy and practice are discussed in relation to the funding of services for people with intellectual disabilities and preventative approaches to addressing the health and social inequalities experienced by people with intellectual disabilities and their families.     

Meaning in life for individuals with physical disabilities

What makes your life meaningful?" is a question previous researchers explored with people of various ages, but not of individuals who have significant physical impairments. In this study, 26 individuals with physical disabilities were asked to describe what makes their lives meaningful. Analysis showed human relationships were the most frequently reported source of meaning in life, the sources being family members, friends, and people in the community. The second most frequently cited meaning was service, specifically, helping and educating others, such as other people with physical disabilities.     

Self-concept and need for achievement of men with physical disabilities.

Self-concept and need for achievement of athletically active and relatively inactive American males with physical disabilities were investigated using the Tennessee Self-Concept Scale Counseling Form (Fitts, 1965) and the Thematic Apperception Test (McClelland, Clark, Roby, & Atkinson, 1949). The subjects were 45 men, ranging from 18 to 40 years old, with physical disabilities. We hypothesized that subjects in the athletically active group had a more favorable mean self-concept and a higher mean need for achievement than subjects in the inactive group. Fifty able-bodied subjects, composing two counterpart groups, were also included in the study. It was hypothesized that the differences regarding the criterion variables between disabled and able-bodied counterpart groups would be negligible. The results of an analysis of variance (ANOVA) and an analysis of covariance (ANCOVA) supported the hypothesis that predicted significant differences at the .025 alpha level between the athletic and the inactive disabled groups. Age, education, and level of disability were treated as covariates. The results of this study also supported the hypothesis that predicted negligible differences (p less than .10) between the disabled subjects and the able-bodied counterpart groups.     

Community-referenced leisure skill clusters for adolescents with multiple disabilities

We evaluated the effectiveness of a training package used to teach student-selected community-referenced leisure skill clusters — ordering a pizza-to-go and renting a video from a local vendor — to two adolescents with multiple disabilities. The adolescents were taught the leisure skills (e.g., ordering the pizza) as well as related behaviors necessary to perform those leisure skills (e.g., using a phone, interacting with the delivery person, cutting and serving pizza, cleaning up). The students were taught functional skill clusters, problem-solving skills, and assistance-seeking skills. Training consisted of didactic instruction, feedback, a least intrusive prompting procedure for incorrect responses, and verbal praise and natural consequences for correct responses. Simulation training was conducted at school and in vivotraining was conducted in the local community. A multiple baseline design demonstrated the controlling effects of treatment. Also, follow-up probes conducted up to five months after treatment showed these students maintained treatment gains. Applied issues related to the efficiency of the training package, general and specific skills training, and factors influencing skill maintenance are discussed.     

A microswitch program to foster simple foot and leg movements in adult wheelchair users with multiple disabilities

This study assessed a microswitch program to foster simple foot and leg movements in 2 adult wheelchair users with multiple disabilities. The participants' mood (indices of happiness) was recorded throughout the study. Data showed that participants rapidly increased the target foot and leg movements and maintained those movements during the course of the study, which lasted about 4.5 months. With regard to indices of happiness, 1 participant showed a fairly modest increase during the intervention while the other participant showed a substantial increase. Implications of the findings are discussed.     

Equivalency of reaction times for simple and primed tasks

Both simple and choice reaction-time tasks have been used to examine the processes involved in response preparation. With a response priming task, complete information prior to the presentation of the imperative stimulus is given as to which response among several will be required. It is assumed that with the priming procedure, the advanced information allows for the complete preparation of the response to be made prior to the presentation of the imperative stimulus [Klapp, S. T. (1996). Reaction time analysis of central motor control. In H. N. Zelaznik (Ed.), Advances in motor learning and control (pp. 13-36). Champaign, IL: Human Kinetics]. This study used two experiments to test the underlying assumption that the processes occurring within the reaction time interval are equivalent for simple and primed tasks, and to determine if the validity of the prime influences performance. In both experiments, participants completed three reaction-time tasks: simple, primed (100%), and choice. The second experiment added a fourth task in which the prime was valid only 80% of the time. In both experiments, the reaction times were significantly slower for the choice task than for either the simple or 100%-primed tasks. Most important, the simple and primed (100%) reaction times were not significantly different. For the second experiment, the reaction times were not significantly different for the choice and 80%-valid prime tasks. The results of these experiments demonstrate that equivalent response preparation processes occur for simple and primed tasks, but that the validity of the prime does influence the response preparation processes for the primed task. Thus, equivalency is not achieved when invalid primes are used.     

Benefits of physical exercise on executive functions in older people with Parkinson’s disease

The benefits of physical exercise on cognitive functioning have been reported in the literature, but the potential benefits to slow the eventual decline in executive functioning (EF) caused by neurodegeneration from Parkinson’s Disease (PD) have rarely been studied. Thus the objective of this study was to analyze the effects of a multimodal physical exercise program on EF in older people with Parkinson’s disease. The EF of the older people was evaluated by neuropsychological testing, and for confounding variables such as attention, depressive symptoms and anxiety, before and after intervention. The 20 participants were assigned into Control (CG) and Trained (TG) Groups. The TG participated in generalized physical training for 6 months. The ANOVA showed a significant interaction (p < .05) that indicated a beneficial contribution of training on EF. No significant interactions were found in the results for confounding variables between groups and pre- and post-intervention, which supports the beneficial findings of physical exercise training on EF.     

Helping a child with multiple disabilities endure a demanding physical posture through self-managed access to preferred stimuli

This study assessed whether a child with multiple disabilities would endure a difficult (standing) position more easily if allowed to access preferred stimuli while in that position. The study included an ABAB sequence with 2- and 3-mo. postintervention checks. Data showed that self-managed access to preferred stimuli during the B phases of the study and the postintervention checks reduced the child's indices of unhappiness, frowning and crying, while increasing his object contact and smiles as indices of happiness.     

Integrating instructional procedures into traditional congregate care situations for people with severe disabilities

Many institutional and community residential agencies experience difficulties in providing habilitative services when direct care staff are working with groups of people with severe disabilities. We evaluated a means of assisting direct care personnel in integrating instructional strategies into traditional congregate care situations. In Experiment 1, integrated teaching strategies were operationalized for two direct care staff persons. The strategies were based on individualized client habilitative goals and the use of brief response prompting and contingent reinforcement paradigms. The staff members integrated the teaching procedures into their group routines with clients upon implementation of an integrated-teaching staff training and management program. The program involved two staff training sessions and ongoing performance feedback. In Experiment 2, four staff members in another living unit integrated the strategies into their group routines upon implementation of a simplified version of the program. Additionally, while the program was in effect, adaptive behaviors increased in frequency for 19 of 20 clients with profound multiple disabilities. Results of the experiments demonstrate a means through which residential agencies may enhance provision of continuous active treatment in accordance with clinical and governmental guidelines. Suggestions for future rescarch are provided, focusing on overcoming obstacles residential personnel face in providing treatment services in congregate situations.