Single Case Experimental Design Study Research Articles

Supporting adherence to a home practice reading program using self-monitoring in persons with aphasia: a single case experimental design study

ABSTRACT Background Impairments in reading comprehension impact participation in daily activities for persons with aphasia. Home practice programs can be used by speech-language pathologists to extend treatment by providing additional practice to support recovery. However, adherence to home programs is often low and factors that enhance adherence to home programs are poorly understood. Aims We sought to examine if using self-monitoring practice with an aphasia-friendly logbook and a timer is an effective mechanism to support home program adherence and to explore the perception of this technique by individuals with aphasia. Methods & procedures This non-concurrent multiple baseline single case experimental design was completed during the COVID-19 Pandemic. Procedures were completed virtually or in person. If in person, assessments were done in the clinic or in the participant’s home. The participants (n = 6) were at least six months post-stroke, diagnosed with aphasia, and reported interest in practicing reading. There were five males and one female. During the baseline phase, participants received training on a mobile reading comprehension application on an iPad. They were instructed to practice reading 80 minutes seven days a week, and were not provided with self-monitoring supports, but were given a single cue card that indicated the practice expectation. The number of data points in the baseline phase was at least five and increased across participants. At the end of baseline, participants received training on the use of a timer and an aphasia-friendly logbook for self-monitoring minutes of practice. They were instructed to continue practicing for 80 minutes every day. In both phases, participants received weekly check-ins to ensure the technology was working. Outcomes & results The primary outcome measures were minutes of practice and percent adherence. Three out of the six participants demonstrated an effect with the self-monitoring intervention with more minutes of practice or greater percent adherence during the intervention phase. Responders typically had higher self-efficacy for exercise scores and a shorter baseline phase. Three participants did not demonstrate an effect of the self-monitoring intervention. The logbook was reported as one of the two most helpful features of the intervention by all the participants with weekly technology check-ins and iPad training as the least helpful elements. Conclusions Self-monitoring with an aphasia-friendly logbook and timer can support some individuals with aphasia in achieving a greater amount of home program practice. Additional research with a larger more diverse sample that incorporates timing and self-efficacy for exercise is warranted.

Effectiveness of a Person-Centered Interdisciplinary Rehabilitation Treatment of Post-COVID-19 Condition: Protocol for a Single-Case Experimental Design Study.

Patients with post-COVID-19 condition (PCC) experience a wide range of complaints (physical, cognitive, and mental), sometimes with high levels of disability in daily activities. Evidence of effective interdisciplinary rehabilitation treatment is lacking. A person-centered, biopsychosocial, interdisciplinary rehabilitation program, adapted to expert opinions and the patient's needs, was therefore developed. This study aims to present a study protocol for a clinical trial to evaluate the effect of a new, person-centered, interdisciplinary rehabilitation treatment for PCC. It is aimed at improving participation in society and health-related quality of life in patients with PCC who perceive a high level of disability in daily activities or participation. A total of 20 Dutch adults, aged 18 years or older, with high levels of disability in daily activities and participation in society will be included in this replicated and randomized single-case experimental design study, from October 2023 onward. The replicated and randomized single-case experimental design consists of 3 phases. The baseline phase is the observational period, in which no specific treatment will be given. In the intervention phase, patients will receive the new outpatient treatment 3 times a week for 12 weeks, followed by a 12-week follow-up phase. During the intervention phase, the treatment will be personalized according to the patient's physical, mental, and cognitive symptoms and goals. The treatment team can consist of a rehabilitation physician, physiotherapist, occupational therapist, speech therapist, and psychologist. The primary outcomes of the study are daily diaries, which consist of 8 questions selected from validated questionnaires (Utrecht Scale for Evaluation of Rehabilitation-Participation, EQ-5D-5L, and the Hospital Anxiety and Depression Scale). The other primary outcome measurements are participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation) and health-related quality of life (EQ-5D-5L). The secondary outcomes are physical tests and validated questionnaires aimed at physical, mental, and cognitive complaints. Effect evaluation based on daily assessments will include visual analysis, calculation of effect sizes (Nonoverlap of All Pairs), randomization tests, and multilevel analysis. In addition, other analyses will be based on ANOVA or a 2-tailed Student t test. Data collection for this study started in October 2023 and is planned to be completed in July 2024. The results will be published in peer-reviewed journals and presented at international conferences. This is the first study investigating the effect of an interdisciplinary rehabilitation treatment with a person-centered, biopsychosocial approach in patients with PCC. Our findings will help to improve the treatment and support of patients with PCC. German Clinical Trials Register DRKS00032636; https://drks.de/search/en/trial/DRKS00032636. DERR1-10.2196/63951.

Assessing the Effectiveness of an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Single-Case and Pre-Post Experimental Design Study.

This study focuses on the Budd app, a mobile health intervention designed for gay, bisexual, and other men who have sex with men who participate in chemsex. Chemsex, the use of psychoactive drugs in a sexual context, presents substantial health risks including increased HIV transmission and mental health issues. Addressing these risks requires innovative interventions tailored to the unique needs of this population. This study aims to evaluate the effectiveness of the Budd app in promoting drug harm reduction practices among its users, focusing on knowledge, behavioral intention, risk behavior awareness, and self-efficacy. The study used a mixed methods approach, combining a single-case experimental design and a pre-post study. A total of 10 participants from an outpatient clinic were recruited, and each attended the clinic 3 times. During the first visit, participants installed a restricted version of the Budd app, which allowed them to report daily mood and risk behavior after chemsex sessions. Phase A (baseline) lasted at least 2 weeks depending on chemsex participation. In the second visit, participants gained full access to the Budd app, initiating phase B (intervention). Phase B lasted at least 6 weeks, depending on chemsex participation, with identical data input as phase A. Participants completed pre- and postintervention surveys assessing behavioral determinants during the first and third visit. The study observed an increased knowledge about chemsex substances postintervention, with a mean percentage improvement in knowledge scores of 20.59% (SD 13.3%) among participants. Behavioral intention and self-efficacy showed mixed results, with some participants improving while others experienced a decrease. There was also a variable impact on awareness of risk behavior, with half of the participants reporting a decrease postintervention. Despite these mixed results, the app was generally well-received, with participants engaging with the app's features an average of 50 times during the study. The Budd app showed effectiveness in enhancing knowledge about chemsex substances among gay, bisexual, and other men who have sex with men. However, its impact on safe dosing behavior, behavioral intention, self-efficacy, and risk behavior awareness was inconsistent. These findings suggest that while educational interventions can increase knowledge, translating this into behavioral change is more complex and may require more participants, a longer follow-up period, and additional strategies and support mechanisms.

Neuromuscular electrical stimulation to combat cognitive aging in people with spinal cord injury: protocol for a single case experimental design study

IntroductionIndividuals with spinal cord injury (SCI) can experience accelerated cognitive aging. Myokines (factors released from muscle cells during contractions), such as brain-derived neurotrophic factor (BDNF), are thought to have beneficial effects on cognition. Neuromuscular electrical stimulation (NMES) was shown to elicit a large release of myokines. However, the effects of NMES on cognitive function have not been studied.ObjectiveTo present the study protocol for a clinical trial evaluating the effects of NMES aimed at improving cognition and BDNF.MethodsA replicated randomized three-phases single-case experimental design (SCED) with sequential multiple baseline time series and a single-armed prospective trial will be conducted with 15 adults with chronic SCI (> 12 months after injury) above L1 neurological level undergoing 30-min quadriceps NMES, 3 days per week for 12 weeks.Main study endpointsPrimary endpoint is cognitive performance (assessed by a smartphone test) conducted three times per week during the baseline phase with random duration of 3 to 8 weeks, the intervention phase of 12 weeks, and the follow-up phase of 3 weeks after a no measurement rest period of 12 weeks. Secondary endpoints are changes in BDNF levels and cognitive performance measured before the baseline period, before and after intervention and after a 12 weeks follow-up.ConclusionThis will be the first study investigating the effects of 12 weeks NMES on both cognition and BDNF levels in individuals with SCI. The SCED results provide information on individual treatment effect courses which may direct future research.Trial registrationClinicalTrials.gov (NCT05822297, 12/01/2023).

The power of Para sport: the effect of performance-focused swimming training on motor function in adolescents with cerebral palsy and high support needs (GMFCS IV) – a single-case experimental design with 30-month follow-up

ObjectiveThis study aims to evaluate the effect of a performance-focused swimming programme on motor function in previously untrained adolescents with cerebral palsy and high support needs (CPHSN) and to determine...

Effect of digital game intervention on cognitive functions in older adults: a multiple baseline single case experimental design study

BackgroundResidents in nursing homes are prone to cognitive decline affecting memory, visuospatial cognition, and executive functions. Cognitive decline can lead to dementia, necessitating prioritized intervention.MethodsThe current study aimed to investigate whether an intervention using a digital game was effective for preserving and improving the cognitive function of residents in nursing homes. An intervention study was conducted using a single-case AB design with multiple baselines. The participants in the study were five older adults aged 65 and over who do not play digital games regularly. The study ran for 15 weeks, including a baseline (phase A) and an intervention phase (phase B). Phase A had five baselines (5 to 9 weeks) with random participant assignment. In phase B, participants engaged in a digital game (Space Invaders) individually. Cognitive function was assessed as the outcome, measured using the Brain Assessment (performed on a tablet through the Internet) at 16 measurement points. Four of five participants (two female and two male) were included in the analysis, using visual inspection and Bayesian statistics with multi-level modeling.ResultsVisual inspection of the graphs revealed cognitive function score improvements after the intervention for most layers in terms of memory of numbers, memory of words, mental rotation test (visuospatial ability), and total scores in the Brain Assessment. These effects were also significant in the analysis by multi-level modeling.ConclusionsThe results suggest that the use of digital games may be effective for preserving and improving cognitive function among residents of nursing home.Trial registrationThis study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000048677; public title: Effect of a Digital Game Intervention for Cognitive Functions in Older People; registration date: August 30, 2022).

Grammar intervention using graduated input type variation (GITV) for pre-primary children: A single-case experimental design study

Purpose This study examined the early efficacy of a new theory-driven principle of grammar intervention, graduated input type variation (GITV). Method Three Cantonese-speaking children, aged between 4;01 and 5;10, with oral language difficulties participated in this single baseline within-participant single case experimental study. The children received a total of 300 teaching episodes of the target serial verb construction via focused stimulation and recast over 10 30- to 45-minute sessions. The 30 exemplars of the target included low type variation of the verbs in each of the first five sessions, followed by high type variation in the remaining sessions. Result Visual analysis revealed that all children improved their performance in the target construction but not the control vocabulary in the probes, suggesting a treatment effect. Maintenance of treatment effects was also observed in all children. Positive results in across-behaviour generalisation to the untrained construction were observed in all children. Generalisation to other less structured linguistic contexts and to the narrative retell discourse context was minimal and observed in one child only. Conclusion Preliminary evidence suggested early efficacy of GITV as a principle for grammar intervention. Modifications in the research methodology are recommended for future studies involving children with developmental language disorder.

Efficacy of an Intensive Exposure Intervention for Individuals With Persistent Concussion Symptoms Following Concussion: A Concurrent Multiple Baseline Single-Case Experimental Design (SCED) Study.

After a concussion, 1 in 3 patients report persistent symptoms and experience long-term consequences interfering with daily functioning, known as persistent concussion symptoms (PCS). Evidence suggests PCS is (partly) maintained by anxious thoughts about brain functioning, recovery, and experienced symptoms, leading to avoidance behaviors, which may prevent patients from meeting life demands. We aimed to investigate the efficacy of a newly developed intensive exposure intervention for individuals with PCS after concussion aimed to tackle avoidance behavior. Participants took part in the intervention at the Maastricht University faculty. Four participants who experienced PCS after concussion partook in the exploratory study. Participants' age ranged between 20 and 32 (mean = 26.5, SD = 5.9) years, with an average length of time after the concussion of 9.8 months. A concurrent multiple-baseline single-case design was conducted. The baseline period (A phase) length was randomly determined across participants (3, 4, 5, or 6 weeks). The exposure intervention (B phase) was conducted by psychologists over a 4-week period and consisted of 3 stages: exploration (2 sessions), active exposure (12 sessions conducted over 1 week), and 2 booster sessions. Participants answered daily questions on a visual analog scale related to symptom experience, satisfaction with daily functioning, and degree of avoidance of feared activities. Additional outcomes included symptom severity, catastrophizing, fear of mental activity, anxiety, depression, and societal participation. Tau-U yielded significant effects ( P < .05) for all participants on all measures when comparing baseline and intervention phases. The pooled standardized mean difference was high for all measures (symptom experience = 0.93, satisfaction of daily functioning = 1.86, and activity avoidance = -2.05). The results show efficacy of the newly developed intensive exposure treatment for PCS after concussion, which is based on the fear avoidance model. Replication in a larger heterogeneous sample is warranted and needed.

Telerehabilitation with Verb Network Strengthening Treatment (VNeST) in two participants with mild-to-moderate and moderate-to-severe aphasia: A single-case experimental design study

ABSTRACT Background Verb Network Strengthening Treatment (VNeST) is a verb-centred aphasia treatment that targets the semantic relationships between a verb (e.g., dig) and related content words (e.g., gardener, hole), aiming to promote word retrieval and sentence production in aphasia. Previous research shows promising results of VNeST in several participants. Aims This study investigates the effects of VNeST through telerehabilitation on word retrieval and sentence production with treated and semantically related untreated verbs, as well as the possible generalisation to confrontation naming and connected speech. Further, functional communication, communicative participation, health-related quality of life and client satisfaction are explored. Methods and Procedures A single-case experimental design study with multiple baselines was conducted with two participants with stroke-induced mild-to-moderate Broca’s aphasia or moderate-to-severe Wernicke’s aphasia who received VNeST through telerehabilitation. Percentage of non-overlapping data, Baseline Corrected Tau and d-index effect size were used to measure improvement in word retrieval and sentence production elicited through video-clip stimuli. The study is registered with ClinicTrials.gov, number NCT05152979. Outcomes and Results The participant with Wernicke’s aphasia improved in word retrieval in sentences with trained and untrained verbs and showed some – albeit limited – generalisation to confrontation naming of nouns and verbs. The participant with Broca’s aphasia withdrew after half of the planned dosage, as he did not consider VNeST suitable for his needs. He did not improve in word retrieval or sentence production. Conclusions VNeST shows promise when it comes to improving word retrieval in trained and semantically related untrained stimuli in moderate-to-severe Wernicke’s aphasia. This study adds to the existing literature by showing potential improvement in VNeST through telerehabilitation.

Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study.

Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=-0.38, 95% CI -0.67 to -0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=-0.31, 95% CI -0.51 to -0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism.

Effectiveness of CO-OP group intervention for children with developmental coordination disorder: single-case experimental design study protocol

IntroductionWith the Cognitive Orientation to daily Occupational Performance (CO-OP) approach, children with developmental coordination disorder learn to use a problem-solving strategy to deal with their motor difficulties and perform daily...

Cognitive behavioural therapy for depression and anxiety in a carer for two family members with dementia: a single case experimental design study.

Evidence suggests that cognitive behavioural therapy (CBT) can be a helpful approach for older adults experiencing anxiety and depression. Some research has suggested this is also the case for those caring for a family member with dementia. Little research has been conducted into the impact of CBT for older adults juggling the demands of caring for multiple family members with dementia. This case study aimed to evaluate the application of CBT to 'Mrs P', a 68-year-old client experiencing anxiety and depression whilst caring for two family members with dementia. A single case experimental design study was conducted to assess the effectiveness of CBT formulation and intervention, including cognitive restructuring of unhelpful thoughts about caregiving and increasing engagement in pleasurable activities. Mrs P's depression and anxiety scores improved significantly throughout treatment, and she met her goal of being able to manage when caregiving activities go wrong during daily life. CBT may be a helpful approach to reducing anxiety and depression in dementia family caregivers.

A single case experimental design study using an operationalised version of the Kaufman Speech to Language Protocol for children with childhood apraxia of speech

Purpose A Phase I study was conducted to examine the treatment effectiveness of the Kaufman Speech to Language Protocol using a research-operationalised protocol. It was hypothesised that articulatory accuracy would improve as a result of the treatment and that these improvements would be maintained after treatment was discontinued. Method A single case experimental design was used to evaluate the effectiveness of the Kaufman Speech to Language Protocol. Four children with a confirmed childhood apraxia of speech diagnosis were included in this study. Each child received 12 individual 1 hr treatment sessions that each consisted of an approximation setting phase and a practice phase. Probe data was collected during treatment and at post-treatment time points to measure treatment effectiveness and to measure changes in the untreated words. Untreated (control) sounds were included to test whether recorded improvements in articulatory accuracy could be attributed to the Kaufman Speech to Language Protocol. Result Two of the four children demonstrated a response to the intervention and maintenance of these changes, while the two remaining children demonstrated some generalisation in the absence of improved target (treatment) words. No specific child factors were clearly associated with positive treatment outcomes. Conclusion This study replicated the findings of an earlier pilot study and found that the operationalised protocol for the Kaufman Speech to Language Protocol is effective in improving articulatory accuracy for some children with childhood apraxia of speech. Additional replication with a further refined treatment protocol and a larger sample size is needed to support a recommendation of clinical use of the Kaufman Speech to Language Protocol.

Weekly Treatment for Childhood Apraxia of Speech With Rapid Syllable Transition Treatment: A Single-Case Experimental Design Study.

The aim of this study was to pilot the efficacy of rapid syllable transition (ReST) treatment when provided once per week for a 50-min treatment session for 12 weeks with five children with childhood apraxia of speech. Of central importance was the children's retention and generalization of gains from treatment as indicators of speech motor learning. A multiple-baseline across-participant design was employed to investigate (a) treatment effect on the 20 treated pseudowords, (b) generalization to 40 untreated real words and 10 untreated polysyllabic word sentences, and (c) maintenance of any treatment and generalization goals to up to 4 months posttreatment. To investigate any difference between in-session performance and retention, a comparison was made between data collected during treatment and probe sessions. Treatment data collected during therapy showed all children improving across their 12 treatment sessions. Three of the five children showed a treatment effect on treated pseudowords in the probe sessions, but only one child showed generalization to untreated real words, and no children showed generalization to sentences. ReST treatment delivered at a dose frequency of once per week was efficacious for only one of the five children. In-session treatment data were not a reliable indicator of children's learning. One session per week of ReST therapy is therefore not recommended. https://doi.org/10.23641/asha.23751018.

Intramuscular Electrical Stimulation for the Treatment of Trigger Points in Patients with Chronic Migraine: A Protocol for a Pilot Study Using a Single-Case Experimental Design.

Background and Objectives: Trigger points (TrPs) are prevalent in patients with migraine headaches. Needling interventions targeting TrPs in migraine patients may reduce the intensity and frequency of headaches, yet systematic reviews reveal a lack of robust evidence. Intramuscular electrical stimulation (IMES) is a modality that delivers electrical current into muscles and TrPs, with recent studies suggesting it may amplify the therapeutic effects of dry needling peripherally and centrally. This could be advantageous for patients with migraine and symptomatic TrPs. Materials and Methods: This study will implement a multiple baseline single-case experimental design (SCED). In a clinical setting, a SCED study lends itself to conducting research with only a few patients that each serve as their own controls. In this SCED study, four participants with chronic migraine will be enrolled in a non-concurrent manner and randomized to one of four baseline measurement periods (4, 5, 6 or 7 weeks), leading to four potentially different start dates for each participant in the intervention phase. During the intervention phase, patients will receive five sessions of dry needling with IMES, one session per week for five weeks. The primary outcome measure will be headache frequency, i.e., the reduction in the number of headache days over a one-month period using electronic headache diary data from the Migraine Buddy smartphone application. Secondary outcome measures will be changes in mean migraine pain intensity using a numeric pain rating scale (NPRS), migraine disability using the Migraine Disability Assessment Test (MIDAS), the Headache Impact Test (HIT-6), and changes in selected cervical musculoskeletal impairments including pressure pain thresholds (PPTs) over TrPs, the craniocervical flexion test (CCFT), and cervical active range of motion (AROM). Primary and secondary outcome measures will be analyzed separately using both visual and statistical analyses. Results: Actively recruiting participants. This project was approved by the Mass General Brigham Institutional Review Board (protocol #2023P000931) and is registered with ClinicalTrials.gov (NCT05893914). Conclusions: This study will seek to determine the effects of a five-week intervention period of IMES to TrPs in the posterior cervical muscles of subjects with chronic migraine.

An integrative treatment model of EMDR and family therapy for children with severe symptomatology after child abuse and neglect: A SCED study

BackgroundChildren who endured child abuse and neglect (CAN) may develop a spectrum of symptoms that goes beyond the development of posttraumatic stress symptoms (PTSS) alone. This can pose unique challenges within the treatment context that may hamper the application of direct trauma-focused treatments. A new treatment model, which focuses on more than PTSS alone, has been developed. Through preparatory work, it aims to engage children in trauma processing. ObjectiveThis study aimed to examine if this integrative treatment model can diminish attachment problems, PTSS, behavior difficulties, and emotional control difficulties in children with a history of CAN who currently reside in permanent placement. Participants & SettingsWe included 15 children between the ages of four and twelve who experienced CAN in the past and who were referred to specialized youth mental health care and their caregivers. MethodsWe conducted a non-concurrent multiple baseline single-case experimental design study with weekly measurements on attachment problems, PTSS, behavior difficulties, and emotional control difficulties through questionnaires. ResultsEight cases were fit to analyze of which all but one participant showed improvement on one or more of the four outcome measures. On group level, we found evidence for functional relationships between the intervention and change in attachment problems, behavioral difficulties, and emotional control difficulties. ConclusionsThis integrative treatment model appears to be a suitable treatment for children with a complex combination of psychiatric problems after CAN and therefore provides promising results for a complex population for whom limited treatment options are available.

Traditional Games: techniques in group guidance for Strengthening Pancasila student profiles in elementary schools

Strengthening the Pancasila student profile is the latest issue in the world of education in Indonesia. All projects and learning methods used aim to shape the character of Pancasila students. This study aims to determine the effectiveness of group guidance using the traditional bilu-bilu game to strengthen the profile of students of Pancasila at SD N 60 Kota Timur. This research is a single case experimental design study with A-B design and involves four respondents using a random sampling method. The instruments used in this study were the Pancasila student profile scale and observation guidelines. The analysis technique used is clinical and statistical analysis. The results showed that there was a significant increase in the profile of Pancasila students through traditional bilu-bilulu games at baseline A1, intervention, and baseline A2. Schools can adapt classic games in guidance and counselling services or in the learning process to strengthen the Pancasila student profile. This study combines group guidance stages with traditional games, allowing students to gain meaningful experiences in each guidance session. The results of this study can be used as a reference for schools to develop group guidance service programs using local wisdom.

Effects of Adaptive Prompts in Virtual Reality-Based Social Skills Training for Children with Autism.

The purpose of this single-case experimental design (SCED) study is to investigate how adaptive prompts in virtual reality (VR)-based social skills training affect the social skills performance of autistic children. Adaptive prompts are driven by autistic children's emotional states. To integrate adaptive prompts in VR-based training, we conducted speech data mining and endorsed micro-adaptivity design. We recruited four autistic children (12-13years) for the SCED study. We carried out alternating treatments design to evaluate the impacts of adaptive and non-adaptive prompting conditions throughout a series of VR-based social skills training sessions. Using mixed-method data collection and analyses, we found that adaptive prompts can foster autistic children's desirable social skills performance in VR-based training. Based on the study findings, we also describe design implications and limitations for future research.

Cognitive behavioural therapy for psychogenic nonepileptic seizures (PNES) in an adult with a learning disability: A case study

AbstractBackgroundPsychogenic nonepileptic seizures (PNES) are attacks that often look like epileptic seizures (ES). Unlike ES, PNES are not triggered by underlying neurological factors. PNES are relatively rare in the general population; however, their prevalence in people with learning disabilities is much higher—up to 10%. Individuals with PNES and learning disabilities often have psychiatric comorbidities, such as anxiety disorders, depression and posttraumatic stress disorder. There are currently no treatment guidelines for PNES in people with or without learning disabilities. However, talking therapies, such as cognitive‐behavioural therapy (CBT), are recommended. This study explores the effectiveness of CBT for the treatment of PNES in a woman (Susan) with PNES and learning disabilities.MethodsWe used a single‐case experimental design (SCED) to investigate the effectiveness of CBT intervention. Specifically, the withdrawal (also known as ABA) design was applied. The patient's average PNES frequency, as well as idiosyncratic mood measure and standardised outcome measures for people with learning disabilities (Glasgow Anxiety Scale for People with an Intellectual Disability and Mini‐Maslow Assessment of Needs Scale‐Learning Disabilities), were used to assess the effectiveness of treatment.FindingsResults show that Susan's monthly PNES frequency reduced from phase A1 (assessment phase) to phase B (treatment phase), and this persisted to the follow‐up phase (phase A2). However, the reduction was not statistically significant. The intervention was associated with improvements in Susan's mood, anxiety and quality of life. Reduction of Susan's anxiety was clinically significant.ConclusionsThis SCED study demonstrates that CBT might be associated with reduction of PNES frequency and improvements in general functioning in people with PNES and learning disabilities; however, further research, especially around confounding variables is needed.

Impact of dynamic light exposure on sleep-wake pattern and BPSD in people with dementia living at home

Dementia is related to disturbances in the sleep-wake pattern, behavioural and psychological symptoms of dementia (BPSD). These phenomena are the main reason for institutionalization. Assistive light technology is relevant to study, as mitigation of BPSD may allow for the improvement of quality of life for both people with dementia and their caregivers. Studies of dynamic light exposure in home-dwelling populations are scarce. In this single-case experimental design study, we evaluated the effects of exposure to dynamic light on the sleep-wake pattern and symptoms of depression, agitation, and anxiety in 11 home-dwelling people with dementia. A four-phase light-exposure therapy oscillating between the control and intervention waves was offered. Objective and questionnaire data were analysed and discussed. The results show that the used dynamic light system did not significantly affect the sleep variables. The severity of BPSD fluctuated in the expected pattern, reducing in intensity with increased light exposure. This pattern was significant for depression and agitation. This longitudinal study included an exploration of a low-cost assistive light intervention within a hard-to-study home-dwelling dementia population. The lessons learned are discussed and recommendations are made for future studies, as this design seems suitable for studying lifestyle interventions to support home-dwelling people with dementia.