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Persons with multiple disabilities, including pervasive motor impairment, may have problems controlling even small responses (e.g., vocal emissions, finger movements, or prolonged eyelid closures) within time-sensitive situations, such as those involved in choice programs. Recent research has indicated that smile expressions can be used as functional choice responses for some of these persons. The present two studies were aimed at assessing the smile response for a child with congenital multiple disabilities and a tongue response for a post-coma man who had recovered his consciousness but presented with pervasive multiple disabilities. The first of the two studies represented a research extension (i.e., a new case with a slightly adapted microswitch technology) concerning the smile response, which had recently been evaluated with few other cases. The second study represented a new effort to assess the tongue response within a choice program and for a post-coma man with multiple disabilities. The results showed that the participants used the smile and the tongue responses successfully while they were apparently unsuccessful in using a slight head/chin movement response. Their choice behavior focused reliably on preferred stimuli and avoided non-preferred stimuli. Implications of the results are discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A recent study has shown that microswitch clusters (i.e., combinations of microswitches) and contingent stimulation could be used to increase adaptive responding and reduce dystonic/spastic behavior in two children with multiple disabilities [Lancioni, G. E., Singh, N. N., Oliva, D., Scalini, L., & Groeneweg, J. (2003). Microswitch clusters to enhance non-spastic response schemes with students with multiple disabilities. Disability and Rehabilitation, 25, 301-304]. The present study was an attempt to replicate the aforementioned study with two boys with multiple disabilities. The adaptive responses selected for the boys consisted of pushing an object with the hand or the back. The dystonic/spastic behavior consisted of body arching (i.e., pushing belly and stomach forward) and leg stretching for the two boys, respectively. Initially, the boys received preferred stimulation for all hand- and back-pushing responses. Subsequently, the stimulation followed only the responses that occurred free from the dystonic/spastic behavior. The results showed that both boys increased the frequency of adaptive responses, learned to perform these responses free from the dystonic/spastic behavior, and maintained this improved performance during a 2-month post-intervention check.

Children with severe or profound intellectual and motor disabilities often present problems of balance and locomotion and spend much of their time sitting or lying, with negative consequences for their development and social image. This study provides a replication of recent (pilot) studies using a walker (support) device and microswitches with preferred stimuli to promote locomotion in two children with multiple disabilities. One child used an ABAB design; the other only an AB sequence. Both succeeded in increasing their frequencies of step responses during the B (intervention) phase(s). These findings support the positive evidence already available on the effectiveness of this intervention in motivating and promoting children's locomotion.

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.

Two single-case studies were carried out using different procedural and technological approaches to enable two adolescents with multiple disabilities to choose among environmental stimuli. Study I focused on replicating a recently developed procedure, which relied on samples of the auditory stimuli available as cues for choice responses. Study II assessed a new procedural and technical setup relying on the use of pictorial representations of the stimuli available as cues for choice responses. The auditory samples and the pictorial representations were presented through computer systems. The participants' choice responses relied on microswitches connected to the computer systems. The data of Study I fully supported previous findings with the same procedural approach. The participant learned to choose preferred stimuli and bypass nonpreferred ones. The data of Study II showed that the participant learned to concentrate his choice. responses on a few stimuli, suggesting that these stimuli were actually preferred and that responding was purposeful. Implications of the results were discussed.

The effects of microswitch-based programs on indices of happiness were evaluated with 9 students who had profound multiple disabilities. Each student received an ABAB sequence in which A represented baseline phases and B, intervention phases. During the latter phases, microswitches were used to enable the students to control preferred environmental stimulation with simple/feasible responses, such as hand-pushing and foot-lifting. Results show that all students increased microswitch responding during the intervention phases. Seven of them also had significant increases in indices of happiness, whereas the other 2 did not. In an attempt to shed some light on the reasons underlying the different outcomes, we examined procedural and methodological aspects of the study.

A program was recently developed to promote adaptive responses and upright head position in students with multiple disabilities through the use of microswitch clusters (i.e., combinations of two microswitches). The five students exposed to the program showed a significant increase in adaptive responses performed with head upright. The first purpose of this study was to carry out a long-term follow-up assessment of the five students' frequencies of adaptive responses and percentages of those responses combined with head upright. Recordings were also made of the length of time the head position was kept during each stimulation period following a successful response event and through the sessions. The second purpose of this study was to arrange a program revision for the students with less favorable data on head upright. The revision consisted of making the stimulation following successful response events synchronous with head upright with a maximum duration of 9s per event. The results of the follow-up assessment showed that two of the students kept the upright head position for nearly the entire stimulation periods that followed successful response events as well as much of the session time. The other three students kept such position for small or intermediate portions of the stimulation periods and of the session time. For these three students, the revised program was applied with substantial benefits. Implications of the findings were discussed.

This study extended the evaluation of microswitch technology (i.e., a position sensor and an optic device), recently introduced for chin and eyelid responses, with two new participants with profound multiple disabilities. The participants were girls of 12.5 and 4.0 years of age who did not possess any specific response that they could profitably use in their environment. The study was conducted according to an ABAB design with a 3-week postintervention check. The results showed that both participants increased their level of responding during the intervention phases and postintervention check compared to the baseline phases. This positive outcome was discussed in terms of (a) the apparent suitability of the technology and responses used in the study, (b) the beneficial implications for the participants, and (c) new developments in the area.

The authors assessed new microswitch clusters (i.e., combinations of two microswitches) and contingent stimulation to increase adaptive responses (i.e., foot and head movements) and reduce aberrant behavior (i.e., finger mouthing)in a boy with multiple disabilities. Initially, intervention was directed at increasing the frequency of each adaptive response, individually, through contingent use of preferred stimuli. Subsequently, adaptive responses led to preferred stimuli only if they occurred in the absence of finger mouthing. Postintervention checks occurred 1, 2, and 3 months after the end of the intervention. Data showed that the boy (a) increased the frequency of the adaptive responses extensively, (b) learned to perform these responses largely free from finger mouthing, and (c) maintained these changes over time. The importance of microswitch clusters to simultaneously pursue the dual objective of promoting adaptive responses and reducing aberrant ones is underlined.

Background: Stimulation and microswitch-based programmes are considered main strategies to promote indices of happiness in students with multiple disabilities. However, only limited attempts have been made to assess the relative effects of the two programmes. This study conducted such an assessment with seven students with multiple disabilities., Methods: The first four phases of the study served to: (1) provide the students with a systematic exposure to each of the programmes; and (2) measure the programmes' effects on indices of happiness by comparing them with baseline levels. The fifth phase served to compare the programmes with each other., Results: The first four phases of the study showed that the microswitch-based programme produced a significant increase in indices of happiness for all seven students, and the stimulation programme produced a significant increase for six students. During the fifth phase of the study (i.e. when the two programmes were alternated), the microswitch-based programme promoted significantly higher indices of happiness than the stimulation programme for four of the seven students., Conclusions: Microswitch-based programmes might be deemed preferable to stimulation programmes because they can promote higher or comparable indices of happiness while promoting the acquisition of adaptive responses and self-determination.

In these two studies, two children with multiple disabilities and minimal motor behavior were assessed to see if they could use chin movements to operate microswitches to obtain environmental stimulation. In Study I, we applied an adapted version of a recently introduced electronic microswitch [Lancioni, G. E., O'Reilly, M. F., Singh, N. N., Sigafoos, J., Oliva, D., & Baccani, S., et al. (2004). Technological aids to promote basic developmental achievements by children with multiple disabilities: evaluating two cases. Cognitive Processing 5, 232-238]. In Study II, we set up a new microswitch detecting the chin-movement response through an optic sensor. Each study was carried out according to an ABAB sequence in which A represented baseline and B intervention phases. A 2-month post-intervention check also occurred. The data showed that both children increased the frequency of the chin response, thus increasing the level of environmental stimulation, during the intervention phases. This performance was retained at the post-intervention check. The overall suitability of this response and related microswitches as well as the need to explore other potential responses and microswitches for children with minimal motor behavior is discussed.

This study assessed (a) whether three girls with multiple disabilities and minimal motor behaviour could acquire pairs of responses taught through micro-switch-based programmes and (b) how the girls would eventually choose between those responses. In relation to the choice issue, a response-choice analysis was conducted to find out whether possible differences in performance rates for the two responses were due to the stimuli linked to them and/or to potential response preferences. Results indicated that all three girls succeeded in the acquisition of the two responses programmed for them and showed clear response choices. The choices seemed to be largely motivated by the stimuli linked to the responses. Implications of these findings were discussed, including the need to assess their generality and extend the scope of the work in this area.

The present study introduced two children (a boy and a girl of 9.2 and 12.3 yr. of age, respectively, with multiple disabilities) to an intervention program for establishing Yes and No responses in relation to preferred and nonpreferred stimuli and assessed the acquisition and generalization of those responses. The program involved the use of microswitches, which monitored the nonverbal Yes and No responses performed by the children and ensured that these responses produced the matching verbal utterances via a vocal output device. Analysis showed children acquired Yes and No responses in relation to the stimuli used for the intervention and, to a comparable degree, to the stimuli used for generalization checks as well. An interview of 30 educational staff of a center for persons with multiple disabilities indicated that they considered the presence of Yes and No verbal utterances preferable to the absence of such utterances, and thought that the utterances could be helpful for the children's response acquisition and would be useful and pleasing for staff and parents. General implications of the findings were discussed.

This study assessed whether two children (11.9- and 9.7-years-old) with profound multiple disabilities and minimal motor behaviour could learn to control environmental stimulation using an eyelid response with a newly developed micro-switch. The response consisted of raising the eyelid markedly (i.e. by looking upward or opening the eyes widely). The micro-switch developed for this target response consisted of an electronically regulated optic sensor mounted on an eyeglasses' frame. Data showed that the children learned the target eyelid response to activate the micro-switch and to increase their level of environmental stimulation. Responding was largely maintained at a 2-month post-intervention check. These results indicate that continued work in this area has positive implications for the rehabilitation of children with most serious disabilities.

Purpose: We assessed the possibility of extending adaptive responding and head control in three children with multiple disabilities through the use of microswitch clusters., Method: The children had previously learned to perform an adaptive hand response and to control head position during that response. They were now taught one or two new adaptive responses (foot lifting, leg touching, or vocalization) and to combine such responses with appropriate head position. Microswitch clusters served to ensure that an adaptive response was followed by positive stimulation only if it was combined with appropriate head position., Results: The results were positive with the children learning the new adaptive responses and combining them with appropriate head position. This performance was maintained during two- or three-month post-intervention checks. During these checks, the children were also successful in using the old adaptive hand response with appropriate head position., Conclusions: The use of microswitch clusters was effective to extend the level of adaptive responding and enhance appropriate head position during this responding. This outcome, which indicates a successful technical replication and procedural extension of previous work in the area, has positive practical implications for educational and occupational programmes for children with multiple disabilities.

This study assessed whether a microswitch duster with favorite stimulation could help a 9.1-yr.-old child with multiple disabilities increase arm-lifting responses without dystonic, sideways head tilting. The microswitch cluster involved two microswitches, one at the child's arm to monitor the lifting response, and the other at the child's head to monitor whether it was tilted during arm lifting. Analysis showed that the percentage of arm-lifting responses occurring without head tilting increased most visibly when favorite stimulation focused on those (appropriate) responses.

This study evaluated the use of micro-switch clusters to improve response activity and posture with two children with multiple disabilities. The children were first taught a hand response and then required to combine this response with appropriate head position. The micro-switch clusters adopted for this purpose consisted of a pressure or mercury micro-switch for the hand response combined with a mercury micro-switch for the head position. Both children had an increase in the frequency of the hand response and in the percentage of times this occurred in combination with appropriate head position. These changes were maintained at a 2-month post-intervention check.

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.

Purpose: This study extended the evaluation of microswitch clusters to support responding and appropriate posture with three students with multiple disabilities., Method: Initially, a baseline level was established for the target response selected for each student. Then, Intervention I was implemented to increase the frequency of that response through the presentation of favourite stimuli. During Intervention II, the response was followed by favourite stimuli only if the microswitch cluster detected it in combination with appropriate posture. Post-intervention checks were carried out within 2 or 3 months from the end of Intervention II., Results and Conclusions: All students showed an increase in the frequency of the target response during Intervention I and in the percentage of times the response occurred in combination with appropriate posture during Intervention II. These changes lasted over time. The importance of microswitch clusters to enhance the performance of students with multiple disabilities was underlined.

This study assessed whether a boy with profound multiple disabilities and minimal motor behavior could learn to use a new response-microswitch combination to control environmental stimulation. The response selected was a chin movement; a mechanical microswitch was set up for this response. The boy learned to use the microswitch, increasing the frequency of the chin response and the level of pleasant stimulation following such response. The performance was retained at a 2-mo. post-intervention check.

Purpose: The study explored whether the use of microswitch clusters could enhance the performance of correct (non-spastic) response schemes by two students with multiple disabilities., Method: The study started with baseline on the two responses selected for each student. Then, intervention was implemented on the first response. This was followed by new baseline and intervention on the second response. Subsequently, intervention sessions on the two responses were alternated. Post-intervention checks were carried out over periods of 4 and 2.5 months., Results and Conclusions: Both students had an increase in correct response schemes and, conversely, a decline in spastic response schemes. The importance and practicality of microswitch clusters to enhance appropriate responding in students with multiple disabilities were discussed.

Background: The present study assessed the feasibility of (1) establishing multiple microswitches and responses (some of which had not been used before) with two children with multiple disabilities, and (2) maintaining such microswitches and responses in the children's daily contexts., Methods: The microswitches were introduced individually and then combined. During the last part of treatment and the follow-up, each child had three microswitches., Results: The data show that both children learned to use all three available microswitches. Moreover, they retained fairly high levels of responding with the microswitches in their daily contexts during follow-up periods of 4 and 6 months., Conclusions: The personal and practical implications of these findings are discussed.