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Purpose: This study assessed a new technology system to help six participants with intellectual and visual disabilities manage leisure engagement and communication with distant partners in an independent manner., Methods: A nonconcurrent multiple baseline design across participants was used to assess the effects of the new technology system. This included a Samsung Galaxy J4 Plus smartphone with Android 9.0 operating system, mini voice recording devices, and a Bluetooth speaker. The smartphone was provided with a Google account and Internet connection. The participants could activate the smartphone's Google Assistant and thus access leisure events, start telephone calls or send messages by triggering mini voice recording devices. Each device, when triggered, uttered a specific verbal request (i.e., a request for a leisure option or for a communication partner to call or to reach by messages). Messages received from those partners were read automatically by the smartphone., Results: During baseline (when the voice recording devices were not available), the participants did not manage to activate the smartphone's Google Assistant and thus did not access leisure events and did not make telephone calls or send messages independently. During the post-intervention phase (when the voice recording devices were available), all participants accessed leisure events and made telephone calls or sent and received messages independently, remaining positively engaged throughout the 10-min sessions. Staff rated the new technology system positively., Conclusion: The new technology system may be a useful resource to help people like the participants of this study access basic leisure and communication independently.Implications for rehabilitationA technology system relying on commercial devices may be practical and acceptable in daily programs for persons with intellectual and other disabilities.Such system may be used for supporting the persons' independent leisure engagement and communication with distant partners.A system may be accessible to persons with significant disabilities if the responses needed to operate it are simple.Simple hand-pressure responses may be sufficient to operate a system that relies on the input of mini voice recording devices.

Background: Smartphone-aided programs were recently developed to support leisure engagement and communication with distant partners in individuals with special needs. This study evaluated an extended smartphone-aided program that supported daily activities in addition to communication and leisure in individuals with intellectual and visual or visuo-motor disabilities., Method: Six participants were involved who had been exposed to an earlier smartphone-aided program supporting communication and leisure. The extended program (a) relied on the use of a Samsung Galaxy J4 Plus smartphone, which was fitted with Android 9.0 operating system and MacroDroid, and (b) alternated periods in which the participants could engage in communication and leisure with periods in which they were provided with instructions for daily activities., Results: During the baseline (i.e., with the earlier smartphone-aided program), the participants engaged in communication and leisure, but did not start any activity. During the post-intervention phase (i.e., with the extended smartphone-aided program), the participants maintained successful communication and leisure engagement and started and carried out daily activities successfully. Staff rated the extended program largely preferable to the original program., Conclusions: The extended program can be a useful tool for widening the functional occupation of individuals like the participants of this study., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To assess a simple technology solution to support basic communication and leisure in people with neurological disorders, extensive motor impairment, and absence of speech., Design: The design was a non-concurrent multiple baseline across participants., Methods: The study included eight participants and assessed a technology setup including a Samsung Galaxy Tab S2 LTE tablet and a Samsung Galaxy A3 smartphone. The smartphone, automated via MacroDroid, presented the participant with leisure, messages, and caregiver options. Choosing leisure or messages (by activating the smartphone's proximity sensor) led the smartphone to present the alternatives available for that option and eventually verbalize the alternative selected. This verbalization triggered the tablet's Google Assistant and led the tablet to present a leisure event or start a message exchange. Choosing the caregiver led the smartphone to invite the caregiver to interact with the participant., Results: During baseline (i.e., when a standard smartphone was available), the participants did not activate any of the options. During intervention and post-intervention (i.e., with the technology described above), participants activated all options and spent most of the session time positively engaged with them., Conclusions: The aforementioned technology seems to be a useful tool for individuals like those involved in this study.

Purpose: This study evaluated a tablet-based program to help eight participants with moderate intellectual disability, sensory and/or motor impairments, and lack of expressive or expressive and receptive verbal skills to select and access leisure activities and video calls independently. Methods: The program relied on the use of a tablet (i.e., Samsung Galaxy Tab S2 LTE) with 8-inch screen, Android 6.0 Operating System, front camera, proximity sensor and multimedia player. The tablet was fitted with a SIM card and two specific applications, that is, WhatsApp Messenger for making video calls and MacroDroid for automating the tablet's functioning in accordance with the program conditions. The tablet presented pictures concerning leisure activities and preferred partners for video calls. The participant could select any activity or partner by touching (or nearing his or her hand to) the tablet's proximity sensor. Results: During the baseline (i.e., without the program), the participants failed to access leisure activities or video calls. During the post-intervention phase (i.e., with the program), they selected and accessed those activities and calls independently and spent between about 75% and 90% of the session time engaging with them. Conclusion: The tablet-based program can be highly beneficial for people like the participants of this study.Implications for rehabilitationA technology-aided program may enable persons with intellectual and other disabilities to independently access leisure activities and communication with distant partners.The program may involve the use of video calls to allow communication to participants with limited or no verbal skills.The program may be realized using a tablet (a) including Android 6.0 Operating System, proximity sensor, and multimedia player, and (b) fitted with a SIM card and applications such as WhatsApp Messenger and MacroDroid.The program may be easily adapted to the participants' characteristics in terms of activities available and partners to reach.

Background: Individuals with extensive neuro-motor impairment and lack of speech tend to remain passive and isolated, and to rely on others for communication and leisure. While their problems are known, only limited evidence is available about intervention tools that could help them curb those problems., Objective: This study was aimed at upgrading and assessing a smartphone-based technology package, which was recently developed to help those individuals to independently engage in basic communication and leisure., Methods: The study included 11 non-ambulatory participants who had no speech or functional active communication. They were provided with (a) a Samsung A3 smartphone with Android 6.0 Operating System, which was fitted with WhatsApp Messenger and programmed via MacroDroid, and (b) cards fitted with radio frequency identification (RFID) tags. By bringing those cards in contact with the back of the smartphone, the participant could start a communication event (e.g., sending a message to a friend) or activate a leisure event (e.g., a song). The smartphone would automatically read to the participant any incoming messages., Results: During the baseline (i.e., when a standard smartphone was available), the participants were unable to engage in communication or leisure. Once the aforementioned technology package was introduced, the participants spent between about 65 and 85% of their session time engaging in communication and leisure., Conclusions: The smartphone-based technology package seems to be a useful tool to support basic communication and leisure in individuals like those involved in this study.

Background: Postcoma persons in a minimally conscious state (MCS) and with extensive motor impairment cannot independently access and control environmental stimulation., Aim: Assessing the effects of a microswitch-aided program aimed at helping MCS persons develop responding and stimulation control and conducting a social validation/evaluation of the program., Design: A single-subject ABAB design was used for each participant to determine the impact of the program on his or her responding. Staff interviews were used for the social validation/evaluation of the program., Setting: Rehabilitation and care facilities that the participants attended., Population: Eleven MCS persons with extensive motor impairment and lack of speech or any other functional communication., Methods: For each participant, baseline (A) phases were alternated with intervention (B) phases during which the program was used. The program relied on microswitches to monitor participants' specific responses (e.g., prolonged eyelid closures) and on a computer system to enable those responses to control stimulation. In practice, the participants could use a simple response such as prolonged eyelid closure to generate a new stimulation input. Sixty-six staff people took part in the social validation of the program. They were to compare the program to basic and elaborate forms of externally controlled stimulation, scoring each of them on a six-item questionnaire., Results: All participants showed increased response frequencies (and thus higher levels of independent stimulation input/control) during the B phases of the study. Their frequencies for each intervention phase more than doubled their frequencies for the preceding baseline phase with the difference between the two being clearly significant (P<0.01). Staff involved in the social validation procedure provided significantly higher scoring (P<0.01) for the program on five of the six questionnaire items., Conclusions: A microswitch-aided program can be an effective and socially acceptable tool in the work with MCS persons., Clinical Rehabilitation Impact: The participants and staff's data can be taken as an encouragement for the use of a microswitch-aided program within care and rehabilitation settings for MCS persons.

Background: Eye-tracking communication devices and brain-computer interfaces are the two resources available to help people with advanced amyotrophic lateral sclerosis (ALS) avoid isolation and passivity., Objective: This study was aimed at assessing a technology-aided program (i.e., a third possible resource) for five patients with advanced ALS who needed support for communication and leisure activities., Methods: The participants were exposed to baseline and intervention conditions. The technology-aided program, which was used during the intervention, (a) included the communication and leisure options that each participant considered important for him or her (e.g., music, videos, statements/requests, and text messaging) and (b) allowed the participant to access those options with minimal responses (e.g., finger movement or eyelid closure) monitored via microswitches., Results: The participants started leisure and communication engagement independently only during the intervention (i.e., when the program was used). The mean percentages of session time spent in those forms of engagement were between about 60 and 80. Preference checks and brief interviews indicated that participants and families liked the program., Conclusions: The program might be viewed as an additional approach/resource for patients with advanced ALS.

Objective: Assessing the impact of microswitch-aided programs with contingent stimulation on response engagement (Study I) and post-session alertness (Study II) of post-coma participants with multiple disabilities., Method: Study I included three participants whose scores on the Coma Recovery Scale-Revised (CRS-R) were 11 or 13. Study II included three participants whose CRS-R scores were 19, 13, and 14. In both studies, the participants received sessions with contingent stimulation (i.e., sessions in which activation of a microswitch with an eyelid or hand response produced 15 s of preferred stimulation) and sessions with general, non-contingent stimulation (i.e., stimulation lasted throughout the sessions)., Results: Study I showed an increase in response engagement/frequencies only during the contingent stimulation sessions. Study II showed that the participants' level of vigilance after those sessions was higher than after non-contingent stimulation sessions., Conclusion: Microswitch-aided programs with contingent stimulation would be more beneficial than programs with general/non-contingent stimulation.

Recent literature has shown the possibility of enabling individuals with multiple disabilities to make telephone calls independently via computer-aided telephone technology. These two case studies assessed a modified version of such technology and a commercial alternative to it for a woman and a man with multiple disabilities, respectively. The modified version used in Study 1 (a) presented the names of the persons available for a call and (b) reminded the participant of the response she needed to perform (i.e., pressing a microswitch) if she wanted to call any of those names/persons. The commercial device used in Study 2 was a Galaxy S3 (Samsung) equipped with the S-voice module, which allowed the participant to activate phone calls by uttering the word "Call" followed by the name of the persons he wanted to call. The results of the studies showed that the participants learned to make phone calls independently using the technology/device available. Implications of the results are discussed.

Objective: Assessing a new camera-based microswitch technology, which did not require the use of color marks on the participants' face., Method: Two children with extensive multiple disabilities participated. The responses selected for them consisted of small, lateral head movements and mouth closing or opening. The intervention was carried out according to a multiple probe design across responses. The technology involved a computer with a CPU using a 2-GHz clock, a USB video camera with a 16-mm lens, a USB cable connecting the camera and the computer, and a special software program written in ISO C++ language., Results: The new technology was satisfactorily used with both children. Large increases in their responding were observed during the intervention periods (i.e. when the responses were followed by preferred stimulation)., Conclusion: The new technology may be an important resource for persons with multiple disabilities and minimal motor behavior.

Objective: To assess a voice-sensitive microswitch for a 67-year-old man with amyotrophic lateral sclerosis (ALS) who had difficulties continuing to use an optic microswitch through small chin movements., Method: The man used the microswitches in combination with a computer-aided program to (a) access preferred songs and videos or make requests, and (b) operate a messaging system to communicate with his wife and sons. To assess the man's performance with the two microswitches, we alternated sessions with one microswitch with sessions with the other., Results: The man's performance with the new microswitch was apparently more efficient (i.e. he could generally activate the new microswitch with a single attempt while he needed a mean of about two attempts for each activation of the optic microswitch). The man also developed a clear preference for the new microswitch., Conclusion: Technology updates are critical within programs for persons with motor degeneration., Implications for Rehabilitation: A microswitch that can be used efficiently and without effort is critically important for a person with ALS. The microswitch can be used with programs that allow the person to manage leisure stimulus events, request opportunities and/or text messaging communication. The microswitch needs to be updated (changed) in relation to the person's physical deterioration.

These two studies were aimed at extending the assessment of technology-aided programs for post-coma persons with extensive motor impairment and lack of speech. Specifically, Study I assessed a new program arrangement, in which stimulation access and caregiver attention could be obtained with variations of the same response (i.e., single- versus double-hand closure) by three participants who were diagnosed at the upper level of the minimally conscious state at the start of the study. Study II was aimed at enabling two persons who had emerged from a minimally conscious state to engage in leisure activities, listen to audio-recordings of family members, and send and receive messages. The responses selected for these participants were hand pressure and eyelid closure, respectively. The results of both studies were positive. The participants of Study I increased their responding to increase their stimulation input and caregiver interaction. The participants of Study II managed to successfully select all the options the program included (i.e., the leisure options, as well as the family and communication options). General implications of the programs and the related technology packages for intervention with post-coma persons with multiple disabilities are discussed., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

These two studies were aimed at extending the assessment of technology-aided programs to enhance leisure occupation or communication with persons with extensive neuro-motor impairment and lack of speech. Specifically, Study I implemented the program for leisure occupation with two post-stroke patients. Study II implemented the program for communication with two persons affected by amyotrophic lateral sclerosis (ALS). In Study I, a computer system presented the participants with a variety of stimuli. The participants could select/access those stimuli by microswitch activation or could bypass them by abstaining from microswitch responses. In Study II, the participants used a computer-aided telephone system that allowed them to choose via microswitch activation the persons to call. On the computer screen, they also had words and phrases that they could activate during the calls to influence the conversation with the persons called. Data from both studies were largely positive. The post-stroke patients showed high levels of stimulus selection (access) and extended engagement. The patients with ALS were able to make phone calls and to select the words/phrases to influence the conversations. The relevance of technology-aided programs for leisure occupation and communication of persons with extensive multiple disabilities was discussed., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Interventions for post-coma persons, who have emerged from a minimally conscious state but present with extensive neuro-motor impairment and lack of or minimal verbal skills, need to promote occupation and communication through the use of assistive technology., Objective: These two studies were aimed at assessing two technology-aided programs to promote leisure engagement and communication for three post-coma participants with multiple disabilities., Methods: Study I assessed a program to allow a woman and a man with extensive neuro-motor impairment and lack of speech to switch on music and videos, make requests to caregivers, and send messages to (communicate with) relevant partners and receive messages from those partners. Study II assessed a program to allow a post-coma woman with extensive motor impairment and reduced verbal behavior to activate music, videos and requests, send and receive messages, and make telephone calls., Results: Data showed that both programs were successful. The participants of Study I managed leisure engagement, requests, as well as text messaging. The participant of Study II showed consistent leisure engagement, text messaging, and telephone calls., Conclusions: Assistive technology can be profitably used to provide post-coma persons with multiple disabilities relevant leisure and communication opportunities.

This study assessed whether a girl and a woman with multiple disabilities could (a) make phone contacts with relevant partners through a special telephone technology, and (b) enjoy their telephone-mediated communication with them. The technology involved a net-book computer, a global system for mobile communication modem (GSM), an optic microswitch, and specific software. The technology was programmed to present the names of the partners available for contact, and the participants could choose at each presentation sequence the one they wanted to contact with a simple microswitch response. Such response triggered the computer to place a phone call to that partner. Both participants (a) learned to use the technology quite rapidly to contact relevant partners and maintained the successful use of it over the intervention and post-intervention sessions, (b) showed high levels of indices of happiness during the phone calls as opposed to pre-baseline control sessions, and (c) showed preferences among the partners. Implications of the findings are discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Post-coma individuals emerging from a minimally conscious state with multiple disabilities may enjoy contact with relevant partners (e.g., family members and friends), but may not have easy access to them. These two single-case studies assessed whether those individuals could make contact with partners through computer-aided telephone technology and enjoy such contact. The technology involved a computer system with special software, a global system for mobile communication modem (GSM), and microswitch devices. In Study I, the computer system presented a 23-year-old man the names of the partners that he could contact, one at a time, automatically. Together with each partner's name, the system also presented the voice of the partner asking the man whether he wanted to call him or her. The man could (a) place a call to that partner by activating a camera-based microswitch through mouth movements or (b) bypass that partner and wait for the next one to be presented. In Study II, the system presented a 36-year-old man the partners' names only after he had activated his wobble microswitch with a hand movement. The man could place a call or bypass a partner as in Study I. The results showed that both men (a) were able to contact relevant partners through the technology, (b) seemed to enjoy their telephone-mediated communication contacts with the partners, and (c) showed preferences among the partners. Implications of the findings are discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To assess whether a man with amyotrophic lateral sclerosis could benefit from using (a) a mouth pressure microswitch instead of an optic microswitch activated via head movement and (b) a special word prediction function within a text messaging system., Method: Initially, both microswitches were used for operating the text messaging system, and their effectiveness and the man's preference were assessed. Subsequently, only the mouth microswitch was used and the messaging system was provided with a word prediction function., Results: The man was more efficient/rapid in using the text messaging (i.e., in writing) with the mouth microswitch and preferred such a microswitch. Similarly, he was more rapid in writing when the word prediction function was added (as opposed to the initial phase of the study when such function was not available) and preferred to use it., Conclusion: Technology updates are critical in helping persons with motor degeneration.

Study I used typical microswitch-cluster programs to promote adaptive responding (i.e., object manipulation) and reduce inappropriate head or head-trunk forward leaning with a boy and a woman with multiple disabilities. Optic, tilt, and vibration microswitches were used to record their adaptive responses while optic and tilt microswitches monitored their posture. The study included an ABB(1)AB(1) sequence, in which A represented baseline phases, B represented an intervention phase in which adaptive responses were always followed by preferred stimulation, and B(1) represented intervention phases in which the adaptive responses led to preferred stimulation only if the inappropriate posture was absent. Study II assessed a non-typical, new microswitch-cluster program to promote two adaptive responses (i.e., mouth cleaning to reduce drooling effects and object assembling) with a man with multiple disabilities. Initially, the man received preferred stimulation for each cleaning response. Then, he received stimulation only if mouth cleaning was preceded by object assembling. The results of Study I showed that both participants had large increases in adaptive responding and a drastic reduction in inappropriate posture during the B(1) phases and a 2-week post-intervention check. The results of Study II showed that the man learned to control drooling effects through mouth cleaning and used object assembling to extend constructive engagement and interspace cleaning responses functionally. The practical implications of the findings are discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This study assessed technology-aided intervention programs for two post-coma men who had re-acquired consciousness, but were unable to engage in personally or socially relevant occupations, given their lack of functional speech and their extensive motor disabilities. The microswitches used for accessing the program contents consisted of (a) a pressure sensor fixed in the palm of the first man's hand that could be activated with a small hand closure movement, and (b) an optic sensor fixed under the chin of the second man that could be activated by mouth opening movements. The programs' content consisted of recreation and communication options, which involved activating music, videos, and basic requests, sending and receiving (listening to) text messages, and placing phone calls. The results showed that the men (a) used the technology-aided programs successfully to manage the recreation and communication options available and (b) showed consistent preference for the sessions with the technology-aided program over other daily events. Family and staff members interviewed about the participants' programs (seven members for each participant) thought that the participants enjoyed the intervention sessions with the programs and that the programs had beneficial effects for them. Implications of the findings are discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This study extended the assessment of a computer-aided telephone system to enable five patients with a diagnosis of Alzheimer's disease to make phone calls independently. The patients were divided into two groups and exposed to intervention according to a non-concurrent multiple baseline design across groups. All patients started with baseline in which the technology was not available, and continued with intervention in which the technology was used. The technology involved a net-book computer provided with specific software, a global system for mobile communication modem (GSM), a microswitch, and lists of partners to call with related photos. All the patients learned to use the system and made phone calls independently to a variety of partners, such as family members, friends, and caregivers. A social validation assessment, in which care and health professionals working with persons with dementia were asked to rate the patients' performance with the technology and with the help of a caregiver, provided generally more positive scores for the technology-assisted performance. The positive implications of the findings for daily programs of patients with Alzheimer's disease are discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A variety of technology-aided programs have been developed to help persons with congenital or acquired multiple disabilities access preferred stimuli or choose among stimulus options. The application of those programs may pose problems when the participants have very limited behavior repertoires and are unable to use conventional responses and microswitches. The present two studies assessed non-conventional response-microswitch solutions for three of those participants. Study I included two participants who were exposed to a program in which forehead skin movement was the response required to access preferred stimulation. The microswitch was an optic sensor combined with a small black sticker on the forehead. Study II included one participant who was exposed to a program in which a smile response was required to choose among stimuli. The microswitch for monitoring the smile was a new camera-based technology. The results of the two studies showed that the response-microswitch solutions were suitable for the participants and enabled them to perform successfully. Implications of the studies for people with limited motor behavior and issues for future research were discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This study assessed technology-aided programs for helping two post-coma persons, who had emerged from a minimally conscious state and were affected by multiple disabilities, to (a) engage with leisure stimuli and request caregiver's procedures, (b) send out and listen to text messages for communication with distant partners, and (c) combine leisure engagement and procedure requests with text messaging within the same sessions. The program for leisure engagement and procedure requests relied on the use of a portable computer with commercial software, and a microswitch for the participants' response. The program for text messaging communication involved the use of a portable computer, a GSM modem, a microswitch for the participants' response, and specifically developed software. Results indicated that the participants were successful at each of the three stages of the study, thus providing relevant evidence concerning performance achievements only minimally documented. The implications of the findings in terms of technology and practical opportunities for post-coma persons with multiple disabilities are discussed., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study extended the research on a special text messaging system, which allows persons with multiple disabilities to (a) write and send messages to distant partners and (b) have messages from those partners read out to them. The study involved two women with multiple disabilities (including blindness or minimal residual vision). The system comprised a net-book computer, a mobile communication modem, and an input microswitch, and relied on special keyboards (not used before) to allow the women to write their messages. One of the keyboards included (a) two rows of 10 and 11 keys, respectively, reporting the 21 basic letters of the Italian alphabet arranged in alphabetical order and marked with Braille labels and (b) a space bar and an enlarged back/erase key. The other keyboard had Braille cues on the initial, central, and final keys of the letter rows. Moreover, most function keys were covered (cut out from the usable space). Both women learned to use the messaging system with the special keyboards successfully (i.e., to write their messages, to send them out, and to listen to incoming messages). These findings are analyzed in relation to preliminary data with the system and the need to adapt the writing technology to the participants' characteristics., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: A camera-based microswitch technology was recently developed to monitor small facial responses of persons with multiple disabilities and allow those responses to control environmental stimulation. This study assessed such a technology with 2 new participants using slight variations of previous responses., Method: The technology involved a computer with a CPU using a 2GHz clock, a USB video camera with 16-mm lens, and special software. Small colour spots were used under the lower lip of one participant and on the eyelid of the other participant to aid the camera and computer to detect their mouth and eyelid responses. The study involved an ABAB design and included a 3-week post-intervention check., Results: The participants' mouth and eyelid responses increased during the intervention (B) phases and post-intervention check (i.e., when the technology allowed them to control stimulation)., Conclusions: Camera-based microswitch technology can help persons with multiple disabilities control stimulation with small responses.

These two studies extended the evidence on the use of technology-based intervention packages to promote adaptive behavior in persons with acquired brain injury and multiple disabilities. Study I involved five participants in a minimally conscious state who were provided with intervention packages based on specific arrangements of optic, tilt, or pressure microswitches (linked to preferred environmental stimuli) and eyelid, toe and finger responses. Study II involved three participants who were emerging from a minimally conscious state and were provided with intervention packages based on computer presentations of stimulus options (i.e., preferred stimuli, functional caregiver's procedures, and non-preferred stimuli) and pressure microswitches to choose among them. Intervention data of Study I showed that the participants acquired relatively high levels of microswitch responding (thus engaging widely with preferred environmental stimuli) and kept that responding consistent except for one case. Intervention data of Study II showed that the participants were active in choosing among preferred stimuli and positive caregivers' procedures, but generally abstained from non-preferred stimuli. The results were discussed in terms of the successful use of fairly new/infrequent microswitch-response arrangements (Study I) and the profitable inclusion of functional caregiver's procedures among the options available to choice (Study II)., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Technology-aided programs for assisting communication and leisure engagement were assessed in single-case studies involving two men with amyotrophic lateral sclerosis (ALS). Study I involved a 51-year-old man with a virtually total loss of his motor repertoire and assessed a technology-aided program aimed at enabling him to (a) write and send out text messages and have incoming messages read to him and (b) establish videophone connections with his children (i.e., establish video contact and communicate with them). Study II involved a 66-year-old man with virtually no motor behavior and apparent depression and assessed a technology-aided program aimed at enabling him to (a) engage in leisure activities and make requests for basic needs and (b) use a low-demand messaging system. The results of both studies were highly encouraging. The participant of Study I could use the technology-aided program for effective communication and social interaction with multiple partners as well as for family interaction. The participant of Study II could use the technology-aided program for leisure engagement, requests, and basic family contacts/communication. The implications of technology for helping persons with severe ALS levels maintain an active and constructive role are discussed., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Persons with a diagnosis of minimally conscious state and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers' attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.

This study assessed whether four patients with a diagnosis of Alzheimer's disease could make independent phone calls via a computer-aided telephone system. The study was carried out according to a non-concurrent multiple baseline design across participants. All participants started with baseline during which the telephone system was not available, and continued with intervention in which such system was used. It involved a net-book computer provided with specific software, a global system for mobile communication modem (GSM), a microswitch, and photos of the persons available for the phone calls. All participants learned to use the system and made phone calls independently to a variety of partners such as family members, friends and staff personnel. The positive implications of the system were discussed in relation to previous data in this area and the possibility of helping persons with Alzheimer's disease restore an important, instrumental daily ability and engage in communication with distant partners., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study assessed a new microswitch arrangement for eyelid responses using an optic sensor placed above the cheekbone and a small sticker on the person's eyelid. This new arrangement, which was designed to avoid interference of the microswitch with the person's visual functioning, was tested on three adults with acquired brain injury and multiple (consciousness, communication, and motor) disabilities. The study was carried out according to a non-concurrent multiple baseline design across participants. Data showed the new microswitch arrangement was suitable for all three participants, who increased their responding during the intervention phase of the study when their responses allowed them to access preferred stimulation. Practical implications of the findings are discussed.

Objective: To expand recently-developed text messaging systems with new technology-based solutions so as to allow persons with multiple disabilities to write messages., Method: Two case studies were conducted. In Study I, the new technology-based solution involved vocal scanning of the alphabet letters to allow letter selection/writing and was assessed with a woman with blindness and extensive motor disability. In Study II, the new technology-based solution involved a touch-screen superimposed on letter symbols arranged alphabetically and was assessed with a man with acquired brain injury, motor disability and lack of speech. Each study involved an ABAB design., Results: Participants learned to write their messages, to send them out and to listen to incoming messages during intervention sessions of nearly 30 and 20 minutes, respectively., Conclusion: Text messaging systems can be developed that allow participants with multiple disabilities to write messages.

Objective: To assess a technology-aided programme for promoting leisure engagement and communication in a man with amyotrophic lateral sclerosis (ALS)., Method: The programme involved a laptop computer equipped with a Clicker 5 software package, an optic microswitch and an interface device. The participant could choose between two leisure options (i.e. songs and videos), could write requests and general messages through a virtual keyboard and a microswitch and could have the written text read out to caregivers and staff., Results: The use of the programme increased the mean frequency of words written to about 15 per 20-minute session during the second intervention phase. Those words were used by the participant for formulating a mean of over two requests/messages per session. The participant also listened to songs and watched videos., Conclusion: A simple technology-aided programme may allow ALS patients to manage leisure engagement and communication.

Objective: To extend the assessment of technology-based programs for promoting stimulus choice and staff/caregiver calls or radio operation and text messaging., Method: In Study I, the program involved a portable computer, commercial software, and a microswitch to allow a man with motor impairment and moderate intellectual disability to choose among preferred stimuli (e.g., songs and film clips) and persons to call. In Study II, the programs involved (a) a radio device and an electronic control unit or (b) a net-book computer and a global system for mobile communication. A woman with blindness and moderate intellectual disability used a microswitch to operate the radio or send and listen to text messages., Results: The participants succeeded in using the technology-aided programs through simple microswitch activations involving partial hand closure (Study I) or hand pressure (Study II)., Conclusion: Technology-based programs can provide persons with multiple disabilities relevant leisure and communication opportunities.

This study was aimed at replicating and extending early research on technology-aided stimulus choice with two adults with multiple disabilities. The technology-aided program involved (a) a computer-aided system presenting the participants samples of different environmental stimuli and (b) a microswitch device allowing them to choose among those samples and to access the related stimuli for preset periods of time. The system also allowed the participants opportunities to request the continuation/repetition of any stimulus. The program was successful in promoting the participants' selection of preferred stimuli and their requests for continuation/repetition of those stimuli. Data also showed that the intervention sessions largely improved the participants' mood (i.e., increased their indices of happiness). Theoretical and practical relevance of the findings were discussed., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study extended the assessment of a newly developed computer-aided telephone system with two participants (adults) who presented with blindness or severe visual impairment and motor or motor and intellectual disabilities. For each participant, the study was carried out according to an ABAB design, in which the A represented baseline phases and the B represented intervention phases, during which the special telephone system was available. The system involved among others a net-book computer provided with specific software, a global system for mobile communication modem, and a microswitch. Both participants learned to use the system very rapidly and managed to make phone calls independently to a variety of partners such as family members, friends and staff personnel. The results were discussed in terms of the technology under investigation (its advantages, drawbacks, and need of improvement) and the social-communication impact it can make for persons with multiple disabilities., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The present two studies extended research evidence on the use of microswitch technology by post-coma persons with multiple disabilities. Specifically, Study I examined whether three adults with a diagnosis of minimally conscious state and multiple disabilities could use microswitches as tools to access brief, selected stimulus events. Study II assessed whether an adult, who had emerged from a minimally conscious state but was affected by multiple disabilities, could manage the use of a radio device via a microswitch-aided program. Results showed that the participants of Study I had a significant increase of microswitch responding during the intervention phases. The participant of Study II learned to change radio stations and seemed to spend different amounts of session time on the different stations available (suggesting preferences among the programs characterizing them). The importance of microswitch technology for assisting post-coma persons with multiple disabilities to positively engage with their environment was discussed., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study extended the assessment of a special messaging technology with two additional post-coma adults who had emerged from a minimally conscious state, but showed multiple disabilities including profound motor and communication impairments. For each participant, the study involved an ABAB design, in which the A represented baseline phases and the B represented intervention phases with the special messaging technology. The technology involved a net-book computer provided with specific software, a global system for mobile communication (GSM) modem, microswitches, and prerecorded verbal lists of persons' names and messages. Both participants learned to send out and receive (listen to) messages independently during the intervention, thus providing clear support for previous data in the area. They sent out means of about three and 17 messages and received means of about two and six messages per 20- and 30-min session, respectively. The positive impact of the technology was discussed in relation to previous data in this area and the possibility of helping post-coma persons with multiple disabilities engage in basic communication with distant partners., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study assessed the use of microswitch technology to promote mouth-drying responses and thereby reduce the effects of drooling by two adults with severe intellectual and multiple disabilities. Mouth-drying responses were performed via a special napkin that contained pressure sensors, a microprocessor and an MP3 to monitor the responses and ensure positive stimulation contingent on them. Initially, the responses produced 10 or 15 s of preferred stimulation. Subsequently, preferred stimulation was supplemented with matching periods of lower-grade stimulation to extend the inter-response intervals. Results showed that both participants (a) learned to dry their mouth consistently and reduce their chin wetness during the intervention, (b) stabilized their responding at lower frequencies as the lower-grade stimulation was added to the preferred stimulation, and (c) maintained the latter levels at a 3-month follow-up. Procedure and response conditions and outcome implications are discussed., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

This study assessed the effectiveness of microswitches for simple responses (i.e., partial hand closure, vocalization, and hand stroking) and a keyboard emulator to facilitate the writing performance of three participants with extensive motor disabilities. The study was carried out according to an ABAB design. During the A phases, the participants (one child and two adults) were to write using the responses and technology available to them prior to this study. During the B phases, they used the new responses and technology. Data showed that two of the three participants had a faster writing performance during the B phases while the third participant had a slower writing performance. All three participants indicated a clear preference for the use of the new responses and technology, which were considered relatively easy and comfortable to manage and did not seem to cause any specific signs of tiredness. Implications of the findings are discussed., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: To assess a computer-aided technology for assisting writing in a man who emerged from a minimally conscious state and presented with extensive motor disabilities., Method: The technology served to present letters, in groups, at the centre of a computer screen and display (write) the letters selected by the man (i.e. through a simplified pointing response) on the upper half of that screen., Results: The results showed that the technology enabled the man to produce clear (readily readable) writing. This writing compared positively with the results obtained using a communication board containing the letters (i.e. a system already available to the man)., Conclusion: Computer-aided technology may provide basic writing (communication) opportunities to persons emerged from a minimally conscious state and affected by extensive motor disabilities and lack of speech.

Objective: To assess whether two persons with multiple disabilities could use smile expressions and new camera-based microswitch technology to select environmental stimuli., Method: Within each session, a computer system provided samples/reminders of preferred and non-preferred stimuli. The camera-based microswitch determined whether the participants had smile expressions in relation to those samples. If they did, stimuli matching the specific samples to which they responded were presented for 20 seconds., Results: The smile expression could be profitably used by the participants who managed to select means of ∼70% or 75% of the preferred stimulus opportunities made available by the environment while avoiding almost all the non-preferred stimulus opportunities., Conclusion: Smile expressions (a) might be an effective and rapid means for selecting preferred stimulation and (b) might develop into cognitively more elaborate forms of responding through the learning experience (i.e. their consistent association with positive/reinforcing consequences).

Objective: To assess whether two women with blindness and additional disabilities could make independent phone calls through a computer-aided telephone system., Method: For each participant, the study involved an ABAB design, in which the A represented baseline phases and the B represented intervention phases with the special telephone system (involving among others a net-book computer with specific software, a global system for mobile communication modem and a microswitch)., Results: Both participants learned to use the system and made phone calls independently to a variety of partners such as family members, friends and staff personnel., Conclusion: The system assessed in this study might represent a useful means for enabling persons with blindness and additional disabilities to manage phone calls on their own.

These two studies assessed camera-based microswitch technology for eyelid and mouth responses of two persons with profound multiple disabilities and minimal motor behavior. This technology, in contrast with the traditional optic microswitches used for those responses, did not require support frames on the participants' face but only small color marks. The person involved in Study I had previously used optic sensors fixed on an eyeglasses' frame for detecting his eyelid- and mouth-opening responses. However, a deterioration of his head posture was making the correct location/use of this frame progressively more difficult. The person involved in Study II had previously been selected for a program relying on eyelid-closure responses and an optic sensor. Such a program however appeared difficult to implement given his sideward lying position and dystonic head movements. The new technology could be satisfactorily applied with both participants using mouth and eyelid opening with the first participant and eyelid closures with the second participant. Both participants had large increases in responding during the intervention periods (i.e., when their responses were followed by preferred stimulation). The findings are discussed in relation to the role of the new technology in helping persons with multiple disabilities and minimal motor behavior., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

This paper presents an overview of the studies directed at helping post-coma persons with minimally conscious state improve their adaptive behavior. Twenty-one studies were identified for the 2000-2010 period (i.e., a period in which an intense debate has occurred about diagnostic, rehabilitative, prognostic, and ethical issues concerning people with severe acquired brain injury). Three of the 21 studies involved transcortical magnetic or deep brain stimulation. Six studies focused on the provision of multisensory stimulation or music therapy. The remaining 12 studies involved the use of response-related (contingent) stimulation and assistive technology. The outcomes of the studies, which were generally reported as positive, were discussed in terms of (a) the size (quantitative relevance) of the changes obtained, (b) the credibility/reliability of the changes, in light of the methodological conditions of the studies, and (c) the level of engagement and interaction involvement of the participants. Relevant issues for future research were also examined., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

These two studies extended previous research on the use of verbal instructions and support technology for helping persons with mild or moderate Alzheimer's disease perform daily activities. Study I included seven participants who were to carry out one of two previously targeted activities (i.e., either coffee preparation or table setting). Study II included four participants who were to carry out two new activities (i.e., preparation of a fruit salad and of a vegetable salad). The effects of activity engagement on mood (i.e., indices of happiness) were assessed by recording the participants' behavior during the activity trials and parallel non-activity periods. The participants of Study I reached percentages of correct activity performance, which normally exceeded 85. Five of them also showed higher indices of happiness during the activity trials as opposed to the non-activity periods. Three of the participants of Study II reached high percentages of correct performance on both activities available. One of these participants also showed higher indices of happiness during the activity trials. The findings were discussed in relation to previous research outcomes and in terms of their practical implications for intervention programs., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The possibility of enabling two adults with acquired brain injury and profound multiple disabilities to use microswitch-based technology to attain preferred environmental stimuli on their own was assessed. Each of the participants was provided with two microswitches that could be activated by right and left head-turning or head-bending responses. The microswitches were introduced sequentially according to a multiple probe design across microswitches (responses) and allowed access to different sets of auditory or visual stimuli. Eventually, the two microswitches were made available simultaneously. Sessions lasted 5 min. Each participant learned to use the two microswitches successfully and maintained consistent levels of responding when they were simultaneously available. During this phase, both participants showed large within-session variations in their right and left response frequencies, with one of them showing an overall prevalence of the left-side response. The importance of assistive technology within programs for persons with acquired brain injury and multiple disabilities is discussed.

This study assessed whether a program based on microswitch and computer technology would enable three post-coma participants (adults) with motor and communication/consciousness impairments to choose among environmental stimuli and request their repetition whenever they so desired. Within each session, 16 stimuli (12 preferred and 4 non-preferred) were scheduled for the participants. For each stimulus, a computer system provided a sample of a 3-s duration. During the intervention, participants' responding (e.g., eye blinking and hand closure) in relation to a stimulus sample activated a microswitch and led the computer system to turn on that stimulus for 20 s. Participants' lack of responding led the computer system to pause briefly and then present the next scheduled stimulus sample. When participants responded immediately after (i.e., within 6s from) the end of a stimulus presentation, that stimulus was repeated. Intervention data showed response increases, which were very consistent for two participants and moderate for the third one. All participants asked for the repetition of preferred stimuli and showed minimal responding in relation to non-preferred stimuli. The results were discussed in light of their possible implications for new, person-centered rehabilitation programs for post-coma persons with multiple disabilities., (2010 Elsevier Ltd. All rights reserved.)

This study assessed a new type of microswitch designed to enable a woman with acquired brain injury and profound multiple disabilities to access environmental stimulation through lip movements. The microswitch involved two optic sensors aimed at detecting changes in lip positions. Data showed that the microswitch was suitable and functional for the participant who increased her responding (lip movements) during the intervention phases of the study, that is, when her responses allowed her to access preferred stimulation. Practical implications of the findings were discussed.

A man with multiple disabilities was taught to use single vs repeated performance of simple motor schemes as different responses. Specifically, single and double emissions of a finger movement served as two separate responses, which allowed direct access to different environmental stimuli via microswitch technology. Single and double emissions of a head movement served as two additional responses, which allowed interaction with two different caregivers who were called via voice output communication aids (VOCAs). The results showed that the man, who had pervasive motor impairment, acquired the four responses available and seemed to use them purposefully. The implications of this approach to increase the response options of persons with few controllable motor schemes were discussed.

Objective: To enable two persons with acquired brain injury and multiple (e.g. motor and visual) disabilities to communicate with distant partners through a special messaging technology, which served to send out text messages and read (listen to) incoming messages., Method: The study was carried out according to a multiple probe design across participants. Both participants (adults) started with baseline in which the technology was not available and continued with intervention in which the technology was used. The technology involved a net-book computer provided with specific software, a global system for mobile communication (GSM) modem, microswitches and pre-recorded lists of persons and messages., Results: The participants' mean frequencies of messages sent out and received per 30-minute session were about three and two, respectively, during baseline and seven and four, respectively, during the intervention. All baseline messages were sent and received with guidance. Nearly all intervention messages were sent and received (listened to) independently by the participants., Conclusions: Special messaging technology may help persons with multiple disabilities acquire high levels of independent, basic communication with distant partners.

Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with minimally conscious state and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music intervals, and (b) a voice output communication aid (VOCA) with two channels, activated via different hand-closure movements, which allowed the man to call his mother and a research assistant who provided stimulation events. Study II assessed a program that included (a) a pressure microswitch, activated via head movements, which allowed a man direct access to video-clips and music, and (b) a VOCA device, activated via prolonged eyelid closure, which allowed the man to call the caregiver (i.e., a research assistant) who provided attention and sung to him. Each of the two participants had significant increases in both microswitch- and VOCA-related responses during the intervention phases of the studies. Moreover, purposeful choice seemed to occur between the two VOCA responses in Study I. Implications of the findings for improving the situation of post-coma persons with minimally conscious state and pervasive motor disabilities are discussed.