Two Children with Multiple Disabilities Increase Adaptive Object Manipulation and Reduce Inappropriate Behavior via a Technology-assisted Program

Abstract

Persons with severe to profound multiple disabilities, such as intellectual, visual, and motor disabilities, may be characterized by low levels of adaptive engagement with the environment (Holburn, Nguyen, & Vietze, 2004; Mechling, 2006). They may also display forms of inappropriate, stereotypical behavior (like hand mouthing, that is, putting their fingers into or over their mouths) or inappropriate postures and dystonic or spastic behavior (for example, tilting their heads forward or stretching their legs) (Lancioni, Singh, O'Reilly, Sigafoos, Didden et al. 2008; Luiselli, 1998; Matson & LoVullo, 2008). Educational efforts that are directed at these persons need to encompass the dual goal of promoting adaptive responses and reducing inappropriate behavior to improve the persons' overall situation. A form of educational intervention that has recently been put forward to pursue such a dual goal relies on programs involving microswitch clusters. One such cluster could be used, for example, to monitor adaptive object manipulation and eye poking and to ensure that the manipulation responses lead to positive stimulation only if performed in the absence of eye poking. Intervention programs that are based on microswitch clusters have been fairly successfully applied by Lancioni and his colleagues with 15 participants with multiple disabilities (see, for example, Lancioni, O'Reilly et al., 2008; Lancioni, Singh, O'Reilly, Sigafoos, Didden et al., 2008; Lancioni, Singh, O'Reilly, Sigafoos, Oliva et al., 2008; Lancioni et al., 2009). The aim of the study reported here was to extend the evidence available by involving two new participants (children), one of whom exhibited an inappropriate behavior that had not been targeted before (dystonic-spastic stretching of one or both arms) and new cluster technology. This technology allowed small manipulations of objects to serve as adaptive responses and to produce positive stimulation and it interrupted any ongoing stimulation if one or both of the participant's hands were withdrawn from the objects for two seconds or more. Basically, the technology did not monitor the inappropriate behavior per se--dystonicspastic stretching of one or both arms or hand mouthing--but a precursor of it (hand withdrawal) via relatively noninvasive devices. METHOD Participants The participants, Glen and Hugh, were 5.6 and 9.9 years old, respectively, and were rated in the severe to profound range of intellectual disability, although no IQ scores were available. They were diagnosed with encephalopathy that was due to premature birth and perinatal hypoxia, presented with spastic tetraparesis combined with dystonic movements for Glen, and spent most of their time in wheelchairs. They had no speech or any other specific means of communication (Glen) or showed some echolalic expressions but with no obvious communication goals (Hugh). On the basis of previous systematic behavioral observations, Hugh was reported to see only light displays in front of him, while Glen was reported to see relatively large objects within about 1 meter (about 39 inches) and at the center of the visual field (see Morse, Teresi, Rosenthal, Holmes, & Yatzkan, 2004; Sakai et al., 2002). Also, Glen had some previous experience with microswitches. Both participants lived at home with their parents and attended daily educational programs that focused on physiotherapy and general stimulation. The study presented here was approved by the scientific and ethics committee of the Lega F. D'Oro, Osimo, Italy. Parents and teachers provided informed consent for the study. Position, adaptive responses, inappropriate behavior, and technology Glen and Hugh were seated at a desk in front of a box that had a base that was 37 centimeters by 27 centimeters (about 15 inches by 11 inches) and was l0 centimeters (about 4 inches) high and open at the top, and contained five to seven objects. …