Technology-Based Behavioral Interventions for Daily Activities and Supported Ambulation in People With Alzheimer's Disease:

Objectives:These 2 studies evaluated technology-based behavioral interventions for promoting daily activities and supported ambulation in people with mild-to-moderate and moderate-to-severe Alzheimer's disease, respectively.Methods:Study 1 included 8 participants who were taught to start and carry out daily activities on their own using a tablet or smartphone device, which provided activity reminders, step instructions, and praise. Study 2 included 9 participants who were taught to engage in brief periods of ambulation using a walker combined with a tilt microswitch and a notebook computer, which monitored step responses and provided stimulation and prompts.Results:The participants of study 1 succeeded in starting the activities independently and carrying them out accurately. The participants of study 2 largely increased their ambulation levels and also showed signs of positive involvement (eg, smiles and verbalizations).Conclusion:The aforementioned technology-based interventions may represent practical means for supporting people with Alzheimer's disease

Fostering Locomotion Fluency of Five Adolescents with Rett Syndrome through a Microswitch-Based Program: Contingency Awareness and Social Rating

We further extended the use of a microswitch-based program for assessing contingency awareness and promoting locomotion fluency of five adolescents with Rett syndrome. A second goal was to evaluate the effectiveness and the suitability of the rehabilitative intervention on participants' indices of happiness as outcome measure of their quality of life and on the reduction of their stereotypic behaviors. Finally, a social validation procedure involving 40 parents of children with severe developmental disabilities and 40 caregivers was carried out. The study was conducted according to an ABABCBCB experimental sequence for each participant, with A representing baselines, B indicating the contingent intervention closely linked to the adaptive responding, and C reporting a non-contingent control phase with positive stimulation occurring throughout the session, irrespective of the adaptive behavior. Results showed an improved performance for all the participants during contingent intervention phases. The control phases revealed that all participants acquired the contingency awareness. The indices of happiness increased as sign of an enhanced quality of life. Both groups of raters favorably scored the use of such technology. Clinical, practical, and psychological implications of the findings were discussed

A simple smartphone-aided program to support meaningful occupation in people with severe neuro-motor and speech disabilities

We assessed a simple smartphone-aided program to help three participants with severe neuro-motor and speech disabilities access preferred songs, call or send messages to distant partners, and call the caregiver. The program relied on the use of a smartphone, five cards with identification tags, and a mini speaker. The participants could select one of the cards (engagement options) by touching it with the smartphone. Using the program, all participants managed to access songs, reach partners, and call the caregiver independently and engaged in the related forms of leisure and communication/interaction throughout the 10-min sessions available. The results suggest that the program might be a valuable aid for people with severe neuro-motor and speech disabilities

Computer and microswitch-based programs to improve academic activities by six children with cerebral palsy

This study was aimed at extending the use of assistive technology (i.e. microswitch such as a pressure sensor, interface and laptop) with a new setup, allowing six children with cerebral palsy and extensive motor disabilities to improve their academic activities during classroom. A second objective of the study was to assess a maintenance/generalization phase, occurring three months after the end of the intervention, at participants' homes, involving their parents. A third purpose of the study was to monitor the effects of the intervention program on the indices of positive participations (i.e. constructive engagement) of participants involved. Finally, a social validation procedure involving 36 support teachers as raters was conducted. The study was carried out according to a multiple probe design across behaviours followed by maintenance/generalization phase for each participant. That is, the two behaviours (i.e. choice among academic disciplines and literacy) were learned first singly, then combined together. Results showed an increasing of the performances for all participants involved during intervention phases. Furthermore, during maintenance phase participants consolidated their results. Moreover, positive participation augmented as well. Support teachers, involved in the social validation assessment, considered the combined intervention as more favourable with respect to those singly learned. Clinical, educational and practical implications of the findings are discussed

Promoting supported ambulation in persons with advanced Alzheimer's disease: a pilot study

Purpose: This study assessed the effects of an intervention program, which combined the use of a walker with assistive technology, on the ambulation and indices of positive involvement of persons with advanced Alzheimer's disease. A social validation assessment of the program was also carried out.Method: The study included 10 participants with moderate to severe Alzheimer's disease and inability to walk independently. During baseline, the participants sat in their chair or were provided with a walker. During the intervention, the participants were provided with the walker and assistive technology, which delivered (a) preferred stimulation contingent on step responses and (b) encouragements to ambulate if needed.Results: The participants' mean step frequencies were between 17 and 45 per session during the baseline and between 83 and 127 per session during the intervention. Sessions lasted 3 min. Most participants also had an increase in indices of positive involvement during the intervention sessions, thus showing an interest in those sessions. The social validation assessment showed that staff personnel rated the program favorably.Conclusions: A program combining the use of a walker with assistive technology may be a practical resource for improving ambulation and positive involvement of persons with advanced Alzheimer's disease.IMPLICATIONS FOR REHABILITATIONA program based on relatively simple technology combined to a walker device may support ambulation in participants with advanced Alzheimer's disease who are no longer able to walk independently.The same program may also help increase the indices of positive involvement (i.e., improve the general attention/activity and mood) of most participants.The staff's positive ratings of the program suggest that there may be a favorable attitude toward the acceptance and application of the program in daily contexts

Assessing learning as a possible sign of consciousness in post-coma persons with minimal responsiveness

A learning test procedure based on operant principles may be useful in the diagnosis (and eventually rehabilitation) of post-coma persons with minimal responsiveness. This study was aimed at extending the evaluation of such a procedure with seven participants who presented with very limited behavior and apparently severe disorders of consciousness. The procedure was evaluated through an ABACB design, in which A represented baseline phases without stimulation, B intervention phases with brief stimulation periods contingent on specific responses of the participants, and C a control phase in which stimulation was available all the time. Increased responding during the B phases, as opposed to the A and C phases, was taken to indicate learning and possibly a non-reflective expression of phenomenal consciousness. All participants were also evaluated with the coma recovery scale-revised (CRS-R) prior to the start of the learning test procedure and at the end of it. The results of the learning test showed that all participants had significantly higher responding levels during the B phases. The CRS-R scores suggested minimally conscious state for four of them prior to the learning test and for five of them after the completion of the learning test. The implications of the findings are discussed in terms of potential and time cost of the learning test

Supporting self-managed leisure engagement and communication in post-coma persons with multiple disabilities

Post-coma persons affected by extensive motor impairment and lack of speech, with or without disorders of consciousness, need special support to manage leisure engagement and communication. These two studies extended research efforts aimed at assessing basic technology-aided programs to provide such support. Specifically, Study I assessed a program for promoting independent stimulation choice in four post-coma persons who combined motor and speech disabilities with disorders of consciousness (i.e., were rated between the minimally conscious state and the emergence from such state). Study II assessed a program for promoting independent television operation and basic communication in three post-coma participants who, contrary to those involved in Study I, did not have disorders of consciousness (i.e., had emerged from a minimally conscious state). The results of the studies were largely positive with substantial levels of independent stimulation choice and access for the participants of Study I and independent television operation and communication for the participants of Study II. The results were analyzed in relation to previous data in the area and in terms of their implications for daily contexts dealing with these persons

Promoting supported ambulation in persons with advanced Alzheimer’s disease: a pilot study

Purpose: This study assessed the effects of an intervention program, which combined the use of a walker with assistive technology, on the ambulation and indices of positive involvement of persons with advanced Alzheimer's disease. A social validation assessment of the program was also carried out.Method: The study included 10 participants with moderate to severe Alzheimer's disease and inability to walk independently. During baseline, the participants sat in their chair or were provided with a walker. During the intervention, the participants were provided with the walker and assistive technology, which delivered (a) preferred stimulation contingent on step responses and (b) encouragements to ambulate if needed.Results: The participants' mean step frequencies were between 17 and 45 per session during the baseline and between 83 and 127 per session during the intervention. Sessions lasted 3 min. Most participants also had an increase in indices of positive involvement during the intervention sessions, thus showing an interest in those sessions. The social validation assessment showed that staff personnel rated the program favorably.Conclusions: A program combining the use of a walker with assistive technology may be a practical resource for improving ambulation and positive involvement of persons with advanced Alzheimer's disease.IMPLICATIONS FOR REHABILITATIONA program based on relatively simple technology combined to a walker device may support ambulation in participants with advanced Alzheimer's disease who are no longer able to walk independently.The same program may also help increase the indices of positive involvement (i.e., improve the general attention/activity and mood) of most participants.The staff's positive ratings of the program suggest that there may be a favorable attitude toward the acceptance and application of the program in daily contexts