Helping Three Persons with Multiple Disabilities Acquire Independent Dressing through Assistive Technology

Abstract

Enabling persons with intellectual or multiple disabilities to carry out personal care tasks (such as washing and dressing) independent of guidance from parents or staff members and without prolonged interruptions is a relevant educational objective (King-Sears & Carpenter, 2005; Lancioni, O'Reilly, Campodonico, & Mantini, 2001; Sewell, Collins, Hemmeter, & Schuster, 1998). Achieving such an objective is often difficult, particularly with persons whose disabilities also include visual impairments (Lancioni et al., 2006), and staff or parental guidance may continue to be needed (King-Sears & Carpenter, 2005). This guidance can be time consuming for staff members or parents and negative for the social image of individuals because it emphasizes their dependence on others (Lancioni, O'Reilly, & Campodonico, 2002). Attempts were recently made to curb the problem of dependency in personal care tasks with the use of assistive technology, which ensured a combination of verbal prompting and preferred stimuli that were automatically delivered on positive performance (see Lancioni et al., 2002, 2006). Three participants were involved in the intervention programs described in these studies, and they all learned to dress themselves. Although these results are encouraging, two aspects of the technology that was used in the interventions raise some questions. First, prompts were delivered at preset intervals, rather than upon the failure to respond of participants. The latter condition would appear preferable in terms of effectiveness and respect for the dignity of participants (Lancioni, O'Reilly, Seedhouse, Furniss, & Cunha, 2000). Second, the prompts and reinforcing stimuli were all auditory. The possibility of using various types of prompts and reinforcing events would be essential for the generalizability of the approach. The goal of the study presented here was to help three new participants with multiple disabilities acquire independent dressing through an upgraded version of the technology. This technology provided prompts only for the failure to respond and included auditory, visual, and vibratory stimuli as reinforcing events or prompts. METHOD Participants The participants, Sylvie, Floyd, and Alan (all names are pseudonyms), were 37, 27, and 29 years old, respectively. They had encephalopathy with a level of functioning estimated to be in the profound range of intellectual disability. Their age equivalents for their daily living skills were about 3 years or younger on the Vineland Adaptive Behavior Scales-Interview Edition (Sparrow, Balla, & Cicchetti, 1984). Sylvie was deaf and had minimal residual vision that allowed her to enjoy light displays and find fairly large objects within about 1 meter (about 39 inches) in front of her and at the center of her visual field. Floyd was totally blind and had typical hearing. Alan was totally blind and deaf and, contrary to the other participants, nonambulatory. These differences in sensory-motor conditions (representative of common variations among individuals with multiple disabilities) allowed for adaptations and a broader evaluation of the assistive technology used in the intervention presented here. All three participants were considered capable of performing the steps of the dressing task, even though Alan needed some physical support to complete the responses of putting on his underpants and pants because of his physical condition. In spite of their general abilities, the three participants still tended to have breaks in performance that required interventions by staff members. Approval for this research was granted by the Scientific and Ethics Committee of the Lega F. D'Oro, Osimo, Italy. The participants were not capable of signing an informed consent form, so their parents did it for them in accordance with Italian law. Setting, dressing task, recording, and reliability The study was carried out in the participants' bedrooms by research assistants who were familiar with the topic of personal care tasks and the delicate issue of respect for the participants' dignity. …