Multiple Baseline Study Research Articles

Sensory Enhanced Interactive Storytelling Technique (SEIS-T): Supporting Active Communication Through Short, Multimodal Narratives

ABSTRACT Creating meaningful interaction can be challenging for communication partners of persons with intellectual disabilities and hearing impairment (IDHI). To elicit moments of interaction and communication, the sensory-enhanced interactive storytelling technique (SEIS-T) has been developed within clinical and educational practice for people with IDHI and their communication partners. SEIS-T uses custom-made storybooks, referential objects and augmentative and alternative communication (AAC). Although many positive communicative moments with SEIS-T have been mentioned by practitioners, scientific research regarding this approach is limited. The present study aimed to alleviate this by examining changes in communication patterns and engagement of children with IDHI over the course of 10 repeated SEIS-T sessions and comparing the results to regular storytelling sessions. Six children participated in a multiple-baseline study. An event-sampling method was applied to analyse videos of the reading sessions, with respect to the children’s verbal and nonverbal communicative acts (role, form and complexity), and their attention to the storytelling. Non-overlap of all pairs (NAP)-analysis was used to test differences between the baseline and intervention phase for each participant. Promising improvements were seen in the frequency and variety of communicative acts by the children and in their focused attention during storytelling, when employing the SEIS-T.

Unlocking the benefits of montessori-based reading activities in nursing home: A multiple baseline study on groups of individuals with severe dementia.

Group activities are commonly offered to residents of nursing homes, and increasingly with a person-centred care approach. The aim of this study is to compare the impacts of a Montessori-based reading activity with a more traditional reading activity. A multiple baseline design was used, with 3 groups of 5 older adults with moderate to severe dementia. All sessions were videorecorded and analysed by independent judges, blinded to our hypotheses and conditions. Impacts of the type of activity (storytelling or Montessori-based reading) on verbal interactions, engagement level, affect and behavioural aspects were estimated with both visual analyses and statistical analyses using the between-case standardised mean differences method. Significant differences were found in favour of the Montessori-based activities with regard to the number of verbal interactions, constructive and passive engagement and positive affect expressed, with moderate to large effect size (from 0.46 to 1.66). The Montessori-based reading group activity really seems to be preferable to a more traditional storytelling activity, with multiple benefits for residents. Depending on the preserved abilities and interests of the participants, it can also be aimed at people with severe dementia.

Improving Movement Behavior in People after Stroke with the RISE Intervention: A Randomized Multiple Baseline Study.

Objective: High amounts of sedentary behavior increase the risk of cardiovascular disease. This study aimed to determine the preliminary effectiveness and feasibility of the RISE intervention to support community-dwelling people with stroke, who are highly sedentary, to reduce and interrupt sedentary time. Additionally, the added value of including participatory support was determined. Methods: A randomized, multiple-baseline study was conducted including 14 participants. All received the RISE intervention, a 15-week blended behavioral intervention in which a primary care physiotherapist provided personalized coaching in the home setting by using behavior-change techniques and the RISE eCoaching system, including an activity monitor and app to provide real time feedback. Half of the participants (randomly allocated) received participatory support from someone from their social network (e.g., partner or close friend) who joined them in the intervention. Preliminary effectiveness was determined with significant changes in total sedentary time and fragmentation (interruption) of sedentary time using a randomization test. Feasibility was assessed by adherence with the intervention protocol, safety, and satisfaction with the intervention. Results: Participants significantly reduced total sedentary time (p = 0.01) by 1.3 h on average and increased their fragmentation (p < 0.01). Subgroup analyses showed significant improvements in both outcomes only in the group with participatory support. Thirteen (92.9%) participants completed the intervention, no related adverse events occurred, and the reported participant satisfaction was sufficient. Conclusions: The RISE intervention appears promising to support people with stroke who are highly sedentary to reduce and interrupt their sedentary time. Participatory support appears to contribute to greater results. Trial registration: ISRCTN international trial registry, 10694741.

Using Virtual Reality to Teach Science Vocabulary to Transition Aged Youth With Intellectual and Developmental Disabilities

Individuals with disabilities have been less involved in school activities than their peers of the same age and this includes career preparation in science and math (Agran et al., 2019; Eriksson et al., 2007; Jackson et al., 2022). Students with disabilities often lack access to facilities, programs, and equipment, and acceptance by educators, employers, and co-workers (Burgstahler, 1994). The effects of a virtual reality (VR) human anatomy application as the means of teaching science vocabulary definitions and locations acquisition for three different human anatomy systems (digestive, respiratory, and integumentary) to college-age students with intellectual disability (ID) are reviewed. This single subject, multiple baseline study included two transition age youth with ID. The intervention package included both a guided and exploratory portion. Data were collected on the participants’ accuracy on the definitions and locations of ten vocabulary words for each of the three body systems on a paper assessment. Findings indicated that a functional relation existed between the implementation of the intervention package and an increase in the accuracy of scores in both definitions and locations for each of the three body systems for each participant.

The Effectiveness and Tolerability of an Intensive Outpatient Trauma Treatment Program for Adolescents With PTSD

Following the promising effects of an intensive trauma treatment for adults, the question arises whether adolescents suffering from posttraumatic stress disorder (PTSD) can also benefit from a similar treatment program. The objective of this study was to assess the effectiveness and tolerability of an intensive trauma treatment program combining two evidence-based, trauma-focused therapies—prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR)—with psychoeducation and physical activity for adolescents suffering from PTSD in an outpatient clinic. We used a multiple-baseline study design. Fifteen adolescents aged 12–18 years old with aDiagnostic and Statistical Manual of Mental Disorders(5th ed.) diagnosis of PTSD were included. Participants were randomized to wait 2, 3, or 4 weeks between the start of baseline and the start of the intervention. In the 2-week intervention period, participants received daily PE, EMDR, and physical activity. The social network of adolescents was involved for support. PTSD symptoms and treatment tolerability were assessed daily. PTSD diagnosis was assessed at baseline and at 1 month and 3 months after completion of treatment. In addition, semistructured interviews were conducted after treatment to determine the tolerability. After treatment, we found a diagnostic PTSD remission of 58%–62% and a decrease in PTSD severity compared with baseline. The effects were maintained at 1-month and 3-month follow-ups. The dropout rate was 13%. Participants reported good treatment tolerability. This study provides initial evidence that an intensive outpatient trauma treatment including PE, EMDR therapy, psychoeducation, and physical activity is effective and tolerable for adolescents with PTSD and is associated with low dropout rates.

Enhancing Grapheme-Phoneme Correspondence Learning: A Single-Case Study Using Picture Mnemonics

The ability to recognize and name the sounds of alphabet letters is a crucial prerequisite for students as they embark on their journey to learn how to read. Regrettably, some children face significant challenges in this area. In this single-case multiple baseline study, we utilized mnemonic pictures to facilitate the memorization of the grapheme-phoneme correspondence of ten target letters. Our aim was to empower four struggling first-grade students to quickly and confidently retrieve this information. The results reveal that the students significantly benefited from the intervention. Furthermore, the approach was perceived as attractive and helpful by both the four children and their teacher. The study concludes by reflecting on its limitations and discussing potential implications and future avenues of research.

Associating white matter microstructural integrity and improvements in reactive stepping in people with Parkinson's Disease.

Reactive steps are rapid responses after balance challenges. People with Parkinson's Disease (PwPD) demonstrate impaired reactive stepping, increasing fall-risk. Although PwPD can improve steps through practice, the neural mechanisms contributing to improved reactive stepping are poorly understood. This study investigated white-matter correlates of responsiveness to reactive step training in PwPD. In an eighteen-week multiple-baseline study, participants (n = 22) underwent baseline assessments (B1 and B2 two-weeks apart), a two-week training protocol, and post-training assessments immediately (P1) and two-months (P2) post-training. Assessments involved three backward reactive step trials, measuring anterior-posterior margin of stability (AP MOS), step length, and step latency. Tract-Based Spatial Statistics correlated white-matter integrity (fractional anisotropy (FA) and radial diffusivity (RD)) with retained (P2-B2) and immediate improvements (P1-B2) in stepping. Significant and sustained improvements in step length and AP MOS were observed. Greater retention of step length improvement correlated with increased FA in the left anterior thalamic radiation (ATR), left posterior thalamic radiation (PTR), left superior longitudinal fasciculus (SLF), and right inferior longitudinal fasciculus (ILF). Step latency retention was associated with lower RD in the left posterior corona radiata and left PTR. Immediate improvements in AP MOS correlated with increased FA of the right ILF, right SLF, and right corticospinal tract. Immediate step length improvements were associated with increased FA in right and left ATR and right SLF. These findings highlight the importance of white-matter microstructural integrity in motor learning and retention processes in PD and could aid in identifying individuals with PD who would benefit most from balance rehabilitation.

Multiple-Baseline Design Study of Deliberate Practice for Learning Psychotherapeutic Techniques

ABSTRACT Deliberate practice is a framework for expertise development that has been applied in many fields but rarely to studies of psychotherapy skill development. The current multiple-baseline study sought to examine the effects of deliberate practice on initial psychotherapy skill acquisition in three completely novice students. In addition to quantitative measures of performance, qualitative feedback concerning their methods of orienting to tasks was also collected regularly. Participants were given a minimal set of instructions to conduct and record psychotherapy role-play exercises, two of whom were provided with opportunities for focal deliberate practice beginning after their 3rd or 5th sessions. Results indicated that deliberate practice was associated with rapid, precipitous increases in reliably coded, structured evaluation of skill, which in many cases approached the cutoff for competent professional CBT practice. The potential of these methods to enhance learning and establish lifelong methods of skill improvement at all performance levels is discussed.

Practitioner Adherence and Competence in MEYA, a Free Online Self-Instruction Program in Modular Psychotherapy and Counseling for Children's Autism-Related Clinical Needs.

The quality of care in public schools and other community settings for school-aged youths on the autism spectrum is variable and often not evidence-based. Training practitioners in these settings to deliver evidence-based practices (EBPs) may improve the quality of care. We developed a free internet-based training and clinical guidance system synthesizing multiple EBPs for youth on the autism spectrum addressing a range of mental health needs and autism-related behaviors, entitled Modular EBPs for Youth on the Autism Spectrum (MEYA; meya.ucla.edu). A multiple baseline study was conducted with seven practitioners recruited from mental health practice settings across the United States who were providing services to children on the autism spectrum (aged 6 to 17years). Practitioners were randomly assigned to undergo baseline conditions of 2 to 8weeks. Once online training in MEYA commenced, practitioners engaged in algorithm-guided self-instruction in EBPs for autism. Participants video-recorded sessions. Independent coders used the MEYA Fidelity Scale (MEYA-FS) to rate adherence and competence in EBPs for autism. Practitioners also completed measures pertaining to implementation outcomes and parents rated youth outcomes on personalized target behaviors. Five of seven practitioners increased their adherence to MEYA practices (i.e., MEYA-FS scores) following MEYA training. Findings for competence were similar, though somewhat less robust. Practitioners generally viewed MEYA as feasible, understandable, and acceptable. Most youth outcomes improved during MEYA. A randomized, controlled trial of MEYA would be helpful in characterizing its effectiveness for supporting practitioner EBP implementation and youth outcomes in school and community service settings.

A 12-week in-phase bilateral upper limb exercise protocol promoted neuroplastic and clinical changes in people with relapsing remitting multiple sclerosis: A registered report randomized single-case concurrent multiple baseline study.

Relapsing-Remitting Multiple Sclerosis manifests various motor symptoms including impairments in corticospinal tract integrity, whose symptoms can be assessed using transcranial magnetic stimulation. Several factors, such as exercise and interlimb coordination, can influence the plastic changes in corticospinal tract. Previous work in healthy and chronic stroke survivors showed that the greatest improvement in corticospinal plasticity occurred during in-phase bilateral exercises of the upper limbs. Altered corticospinal plasticity due to bilateral lesions in the central nervous system is common after Multiple Sclerosis, yet the effect of in-phase bilateral exercise on the bilateral corticospinal plasticity in this cohort remains unclear. Our aim was to investigate the effects of in-phase bilateral exercises on central motor conduction time, motor evoked potential amplitude and latency, motor threshold and clinical measures in people with Relapsing-Remitting Multiple Sclerosis. Five people were randomized and recruited in this single case concurrent multiple baseline design study. The intervention protocol lasted for 12 consecutive weeks (30-60 minutes /session x 3 sessions / week) and included in-phase bilateral upper limb movements, adapted to different sports activities and to functional motor training. To define the functional relation between the intervention and the results, we conducted a visual analysis. If a potential sizeable effect was observed, we subsequently performed a statistical analysis. Results demonstrated bilateral reduction of the motor threshold alongside with improvement of all clinical measures, but not in any other corticospinal plasticity measures. Our preliminary findings suggest that in-phase bilateral exercise affects motor threshold in people with Relapsing-Remitting Multiple Sclerosis. Therefore, this measure could potentially serve as a proxy for detecting corticospinal plasticity in this cohort. However, future studies with larger sample sizes should validate and potentially establish the effect of in-phase bilateral exercise on the corticospinal plasticity and clinical measures in this cohort. Clinical trial registration: ClinicalTrials.gov NCT05367947.

Effectiveness of compassion-focused therapy for self-criticism in patients with personality disorders: a multiple baseline case series study.

Targeting self-criticism, the tendency to negatively evaluate and judge aspects of oneself, may improve treatment efficacy for personality disorders (PDs). This study aimed to test whether adding 12-week group compassion-focused therapy (CFT) that explicitly targets self-criticism to treatment as usual (TAU) would reduce self-criticism in patients with PDs. Twelve patients with PDs participated in a multiple baseline study, randomly allocated to different baseline lengths. The primary outcome was twice-weekly assessed self-critical beliefs during baseline, treatment, and follow-up phases. Secondary outcomes were self-criticism, self-compassion, and PD severity at the end of CFT and follow-up (trial registered: NL8131). Nine participants completed the intervention. No significant changes were observed during CFT, but at follow-up significant decrease in self-critical beliefs (Cohen's d = -0.43; 95% CI = -0.73 to -0.12) was reported compared to baseline. On secondary outcomes, most participants showed reliable improvement on self-reported criticism (66.7%) and self-compassion (55.6%), and a minority of patients showed reliable improvement in PD severity (33.3%). This study seems to provide preliminary evidence for the effectiveness of 12-week CFT for self-critical beliefs in patients with PDs compared to TAU. CFT for self-criticism in PDs may complement treatment offerings and warrant further research.

Preliminary efficacy of a transition training program for autistic adolescents

PurposeYoung autistic adults experience poor transition outcomes in the area of employment. With reduced opportunities to develop work skills, there are also reduced opportunities for socialization, independence and experiences of success. Thus, there is a need for transition planning programs for autistic adolescents and youth. MethodThis pilot study employed two complementary methodologies. A non-concurrent multiple baseline study using a visual analog scale (VAS) as the repeated measure was employed. Pre post measures were also collected from the parent participant and student participants’ perspective using two standardized measures. The thirteen student participants, age 12–18 years all had a diagnosis of autism. Seven parent and 6 adolescents completed the pretest and posttest measures.The Project FUSE, Fostering Unlimited Success and Empowerment intervention program was a collaboration between two organizations, designed to build skills in the workplace, while also addressing sensory processing, arousal regulation and establishing productive relationships. Visual analog ResultsThe three VAS questions most sensitive to change were related to prideful behavior, developing work skills and safety in tool use. There was no significant change in the Transition Behavior Scale: Third Edition. The Culture Free Self Esteem Inventories, Third Edition showed significant, meaningful change in the Global Self Esteem Quotient, and Academic Self –Esteem. ConclusionProject FUSE was found to be a potentially efficacious method for developing pre-employment skills in autistic youth. The data suggest that the programming had a positive influence on developing work skills, tool safety, and self-esteem.

Tiers 1 and 2 of a German MTSS: impact of a multiple baseline study on elementary school students with disruptive behavior

IntroductionThe prevalence of disruptive behavior is increasing worldwide, affecting the learning process and classroom climate, teacher–student relationships, and peer interactions. Disruptive behavior in childhood can have detrimental effects on a child’s long-term growth and may predict similar behavior in adolescence and adulthood. Thus, it is not only contemporary education and school research that are concerned with addressing the issues of teacher workload reduction and improvement of students’ learning environment, but it is also a socially relevant issue. The Multi-tiered Systems of Supports (MTSS) effectively mitigates some of these challenges in the education system and is recognized as a successful framework.MethodsTherefore, this single-case study examined the first two tiers of an MTSS developed in Germany (Multimo) to determine the impact of its implementation on 32 students with disruptive behavior. The first hypothesis propose that the implementation of Tier 1 can effectively decrease disruptive behavior among all students and the second one that assigning students to Tier 2 can provide an additional reduction in disruptive behavior. Data analysis included multilevel analyses with piecewise-multilevel models and the overlap index, the Nonoverlap of All Pairs, based on teachers’ direct behavior rating. All analyses focused exclusively on the outcome variable of disruptive behavior, which was estimated based on teachers’ daily behavior ratings.ResultsThe results of the study showed a significant reduction of disruptive behavior in elementary school students at Tier 1. Disruptive behavior decreased at Tier 2 as well but did not show a significant change compared with Tier 1.DiscussionThe study concludes that in the context of an MTSS, the Good Behavior Game and Daily Behavior Report Card can be used together.

A pilot multiple-baseline study of a mobile cognitive behavioral therapy for the treatment of eating disorders in university students.

Eating disorders (EDs) are serious psychiatric disorders associated with substantial morbidity and mortality that are prevalent among university students. Because many students do not receive treatment due to lack of access on university campuses, mobile-health (mHealth) adaptations of evidence-based treatments represent an opportunity to increase treatment accessibility and engagement. The purpose of this study was to test the initial efficacy of Building Healthy Eating and Self-Esteem Together for University Students (BEST-U), which is a 10-week mHealth self-guided cognitive-behavioral therapy (CBT-gsh) app that is paired with a brief 25-30-min weekly telehealth coaching, for reducing ED psychopathology in university students. A non-concurrent multiple-baseline design (N = 8) was used to test the efficacy of BEST-U for reducing total ED psychopathology (primary outcome), ED-related behaviors and cognitions (secondary outcomes), and ED-related clinical impairment (secondary outcome). Data were examined using visual analysis and Tau-BC effect-size calculations. BEST-U significantly reduced total ED psychopathology and binge eating, excessive exercise, and restriction (effect sizes ranged from -0.39 to -0.92). Although body dissatisfaction decreased, it was not significant. There were insufficient numbers of participants engaging in purging to evaluate purging outcomes. Clinical impairment significantly reduced from pre-to-post-treatment. The current study provided initial evidence that BEST-U is a potentially efficacious treatment for reducing ED symptoms and ED-related clinical impairment. Although larger-scale randomized controlled trials are needed, BEST-U may represent an innovative, scalable tool that could reach greater numbers of underserved university students than traditional intervention-delivery models. Using a single-case experimental design, we found evidence for the initial efficacy of a mobile guided-self-help cognitive-behavioral therapy program for university students with non-low weight binge-spectrum eating disorders. Participants reported significant reductions in ED symptoms and impairment after completion of the 10-week program. Guided self-help programs show promise for filling an important need for treatment among university students with an ED.

The Effectiveness of Reactive Step Training in People with Multiple Sclerosis

Background and Purpose Falls are poorly controlled in people with Multiple Sclerosis (PwMS). Reactive stepping after a loss of balance has been associated with falls and is altered in PwMS. However, there is limited data regarding whether reactive step training improves steps in PwMS. We aimed to determine whether reactive stepping improved following two weeks of reactive step training in PwMS. Methods To date, 16 PwMS participated in an 18-week multiple baseline study. Participants attended 2 baseline assessments (B1 and B2) before training, a 2-week, 6-session training protocol, and 2 post-training assessments (P1 and P2) to assess acute (P1) and retained (P2- 8 weeks post-training) effects. Each assessment consisted of 3 backward reactive step trials. Training consisted of 32 stepping trials in the forward, backward, left, and right directions. Outcomes included the anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Repeated measures ANOVAs were assessed training (B2 - P1; n = 16) and retention (B2 – P2; n = 8) effects. Performance change and effect sizes (η2- partial eta-squared, 0.01 small, 0.06 medium, 0.14 large) were interpreted as data collection is ongoing. Results In this interim analysis, immediately after training, participants demonstrated quicker (-45 ms, η2= 0.15) and larger steps (+2.5 cm, η2= 0.09), with a larger MOS (+3 cm, η2= 0.12) than before training. Despite only 8 participants completing the 8-week follow-up thus far, improvements in MOS (+ 3cm, η2= 0.11), step length (+7 cm, η2= 0.20), and step latency (-10 ms, η2= 0.03) were retained 2 months after training compared to B2. Discussion These interim findings suggest that reactive step training may be an effective approach to improve reactive balance in PwMS. Given the importance of reactive stepping for fall prevention, this work may impact rehabilitative care and reduce fall-risk for PwMS. Falls are poorly controlled in people with Multiple Sclerosis (PwMS). Reactive stepping after a loss of balance has been associated with falls and is altered in PwMS. However, there is limited data regarding whether reactive step training improves steps in PwMS. We aimed to determine whether reactive stepping improved following two weeks of reactive step training in PwMS. To date, 16 PwMS participated in an 18-week multiple baseline study. Participants attended 2 baseline assessments (B1 and B2) before training, a 2-week, 6-session training protocol, and 2 post-training assessments (P1 and P2) to assess acute (P1) and retained (P2- 8 weeks post-training) effects. Each assessment consisted of 3 backward reactive step trials. Training consisted of 32 stepping trials in the forward, backward, left, and right directions. Outcomes included the anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Repeated measures ANOVAs were assessed training (B2 - P1; n = 16) and retention (B2 – P2; n = 8) effects. Performance change and effect sizes (η2- partial eta-squared, 0.01 small, 0.06 medium, 0.14 large) were interpreted as data collection is ongoing. In this interim analysis, immediately after training, participants demonstrated quicker (-45 ms, η2= 0.15) and larger steps (+2.5 cm, η2= 0.09), with a larger MOS (+3 cm, η2= 0.12) than before training. Despite only 8 participants completing the 8-week follow-up thus far, improvements in MOS (+ 3cm, η2= 0.11), step length (+7 cm, η2= 0.20), and step latency (-10 ms, η2= 0.03) were retained 2 months after training compared to B2. These interim findings suggest that reactive step training may be an effective approach to improve reactive balance in PwMS. Given the importance of reactive stepping for fall prevention, this work may impact rehabilitative care and reduce fall-risk for PwMS.

White Matter Correlates of Reactive Stepping in People with Multiple Sclerosis

Background and Purpose Reactive steps are rapid protective responses after balance challenges. People with MS (PwMS) demonstrate impaired stepping, which can increase fall-risk, and these deficits may be caused by white matter (WM) loss. However, the specific neural mechanisms contributing to reactive stepping in PwMS are poorly understood. We aimed to determine WM correlates of reactive stepping and responsiveness to step training. Methods 14 PwMS participated in an 18-week multiple-baseline study. Participants attended 2 baseline assessments (B1 and B2) before training, a 2-week, 6-session training protocol, and a post-training assessment (P1). Each assessment consisted of 3 backward reactive step trials. Training consisted of 32 stepping trials. Outcomes included the anterior-posterior margin of stability (MOS), step length, and step latency. Tract-Based Spatial Statistics (TBSS) was performed to investigate the WM microstructure by correlating fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) with baseline reactive step performance (B1) and immediate responsiveness to training (P1). Results The FA of the right superior longitudinal fasciculus (R-SLF) was associated with baseline step length (p=0.048) and MOS (p=0.048). Corpus Callosum (p=0.047) and right anterior corona radiata (R-ACR) (p=0.047) FA were also related to baseline MOS during backward stepping. FA of the corticospinal tract was also associated with baseline step length (p=0.048). The FA (p=0.047) and the MD (trending- p=0.082) of the L-ACR were also related to step length. No significant associations were found between WM and training responsiveness, but a trend showed an association between the right uncinate fasciculus and a change in step latency (p=0.072). Discussion We identified several WM loci associated with baseline stepping involved in the rapid integration of sensory information and the execution of motor responses. A better understanding of the neural control of reactive stepping may lead to developing more effective rehabilitation strategies and ultimately reducing fall-risk in PwMS. Reactive steps are rapid protective responses after balance challenges. People with MS (PwMS) demonstrate impaired stepping, which can increase fall-risk, and these deficits may be caused by white matter (WM) loss. However, the specific neural mechanisms contributing to reactive stepping in PwMS are poorly understood. We aimed to determine WM correlates of reactive stepping and responsiveness to step training. 14 PwMS participated in an 18-week multiple-baseline study. Participants attended 2 baseline assessments (B1 and B2) before training, a 2-week, 6-session training protocol, and a post-training assessment (P1). Each assessment consisted of 3 backward reactive step trials. Training consisted of 32 stepping trials. Outcomes included the anterior-posterior margin of stability (MOS), step length, and step latency. Tract-Based Spatial Statistics (TBSS) was performed to investigate the WM microstructure by correlating fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) with baseline reactive step performance (B1) and immediate responsiveness to training (P1). The FA of the right superior longitudinal fasciculus (R-SLF) was associated with baseline step length (p=0.048) and MOS (p=0.048). Corpus Callosum (p=0.047) and right anterior corona radiata (R-ACR) (p=0.047) FA were also related to baseline MOS during backward stepping. FA of the corticospinal tract was also associated with baseline step length (p=0.048). The FA (p=0.047) and the MD (trending- p=0.082) of the L-ACR were also related to step length. No significant associations were found between WM and training responsiveness, but a trend showed an association between the right uncinate fasciculus and a change in step latency (p=0.072). We identified several WM loci associated with baseline stepping involved in the rapid integration of sensory information and the execution of motor responses. A better understanding of the neural control of reactive stepping may lead to developing more effective rehabilitation strategies and ultimately reducing fall-risk in PwMS.

A Sensory Integration Intervention in the School Setting to Support Performance and Participation: A Multiple-Baseline Study.

There is a paucity of research that explores the effectiveness of sensory integration interventions in the school setting. To test the effectiveness of a sensory integration intervention paired with teacher consultation, aligned with the principles of Ayres Sensory Integration® and the Sensory Therapies and Research Frame of Reference, to improve functional regulation and active participation in school for students with sensory integration and processing differences. Concurrent, multiple-baseline, single-subject design. Public elementary school in the United States. Students (N = 3; ages 5-8 yr) whose sensory integration and processing differences were affecting their school occupational performance and were not remediated by integrated support. For 15 wk, each student had one-to-one sensory integration intervention 2×/wk for 30 min and a consultation between the occupational therapist and teacher weekly for 10 min. The dependent variables, functional regulation and active participation, were measured weekly. The Short Child Occupational Profile and Behavior Assessment System for Children, Third Edition, were given before and after intervention. Goal Attainment Scaling and semistructured interviews with the teachers and participants were completed after intervention. All 3 students showed meaningful improvement in functional regulation and active participation in the classroom during the intervention period as demonstrated by a 2-SD band method or celeration line analysis. All additional measures noted positive change. Findings suggest that sensory integration intervention with consultation in the education setting can improve school performance and participation for children with sensory integration and processing challenges. What This Article Adds: This study offers an evidence-based model of service delivery for the school setting that is effective in improving the functional regulation and active participation of students whose sensory integration and processing challenges interfere with occupational engagement and are not mitigated by embedded supports.

Father-Child Playfulness: A Secondary Analysis of a Multiple-Baseline Single-Subject Study of Three Children With Autism Spectrum Disorder.

Ayres Sensory Integration® (ASI) is commonly used with children on the autism spectrum to promote sensory processing and improved occupational performance, including play. To date, there has been no explicit effort to examine improvements in playfulness through ASI. To explore whether ASI, coupled with parent training, improves child playfulness and fathers' support of child playfulness. Single-subject A-B-BC design secondary analysis of a nonconcurrent multiple-baseline study. Occupational therapy clinic. Three father-child dyads; children were ages 3 to 6 yr, with autism spectrum disorder (ASD) and documented sensory processing concerns. After a baseline phase, each child received at least 24 sessions of ASI, and fathers received parent training focusing on sensory processing issues and play via an online presentation. The Parent/Caregiver's Support of Children's Playfulness and the Test of Playfulness. Visual analysis of the baseline phase, ASI phase, and ASI with parent training phase shows that all 3 fathers demonstrated an increase in the way they supported their child's playfulness; however, this change was not maintained. Children's playfulness fluctuated, reaching a peak after fathers received training, but none of the children maintained that change. Additional support by the therapist is required for fathers to learn and use new strategies to promote consistent change in child playfulness during play. Pilot data can be used to inform future studies. What This Article Adds: Occupation- and family-centered frameworks may be useful in guiding practice when working with families of children with ASD.

The effectiveness of a cognitive-plus-motivational reading intervention: A multiple-baseline study with four pupils at-risk for reading difficulties

AimsWe aimed to examine the impact of supplementing cognitive reading intervention with supports for reading motivation on the reading motivation (reading interest and self-efficacy) and reading fluency of four Year four pupils at-risk for reading difficulties.Method/rationaleCase studies of four pupils at-risk for reading difficulties were conducted using a multiple-baseline across-participants design. The effects of a combined Cognitive-plus-Motivational intervention (experimental phase) were compared to those of a Cognitive-Only intervention (baseline phase) using probes for reading fluency, interest, and self-efficacy. Scores on each probe were plotted and analysed by combining visual analysis and the Process Control Chart method of analysis.FindingsResults suggest that compared to a Cognitive-Only intervention, the Cognitive-plus-Motivational intervention improved the fluency of three participants, and the interest and self-efficacy of two out of four participants. Findings provided insight into individual patterns of response to the intervention, with the greatest impact on fluency observed for students with the lowest initial reading skills.LimitationsCaution is needed in generalising findings due to the study’s small sample size, the lack of a control group and the potential presence of experimenter bias.ConclusionsThe findings presented here provide preliminary support for the benefits of supplementing reading intervention with instruction to foster reading motivation on the outcomes of pupils at-risk for reading difficulties and provide insight into patterns of individual response to motivational intervention.

A preliminary evaluation of unified protocol in anxiety disorders in India: a multiple baseline study protocol

Background: Anxiety disorders are highly prevalent with high rates of comorbidity. Single disease protocols have been the predominant choice of psychological treatment, however, there has been an increasing focus on transdiagnostic, shared mechanisms. Unified protocol is an emotion-focused CBT that addresses core vulnerabilities by training individuals in adaptive emotion regulation skills. UP has gained research attention in the management of emotional disorders with its modular approach. A challenge in psychotherapy research has been to understand the mechanisms of interventions and their effect on symptoms. Thus single-case experimental design has the potential to address some of the key questions. We present a research protocol that aims to examine the effectiveness of the unified protocol, using the SCED. Methods: A single-case experimental design, with multiple baseline assessments, will be employed, with random allocation to 2- or 3-week baselines. Patients with a primary diagnosis of anxiety disorder, consenting to baseline assessments, and stabilized at least for 4 weeks of medication will be recruited. Assessments will be carried out at baseline, post, and three months, in addition to weekly assessments on the primary outcome measure, anxiety by an independent blind rater. Secondary outcomes include intolerance to uncertainty, neuroticism, emotion regulation, and anxiety sensitivity. Conclusions: The findings of this study would contribute to the empirical status of transdiagnostic interventions in symptom reduction and in addressing shared mechanisms, enhancing its clinical relevance for co-morbid disorders. Trial Registration: The study has been registered in clinical trials registry of India, No. CTRI/2021/01/030803; 28 January 2021.