Biomedical Engineering Reference
In-Depth Information
the development of any specific response schemes by the individuals. In fact, they would not
need any such schemes to access environmental stimulation. This lack of opportunity/neces-
sity may be seen as a critically negative perspective from a learning and education/rehabilita-
tion standpoint (Glickman et al. 1996; Holburn et al. 2004; Lancioni et al. 2004c, 2008b, 2009b).
A possible way to help these individuals with profound and multiple disabilities deal
with their situation is the use of microswitch technology or variations thereof such as
voice output communication aids (VOCAs) (Leatherby et al. 1992; Sullivan and Lewis 1993;
Sullivan et al. 1995; Lancioni et al. 2001a, 2008b; Mechling 2006). Microswitches are tech-
nical devices that are built to work as functional tools, that is, tools that allow persons
with profound and multiple disabilities to acquire control of environmental events with
minimal responses (i.e., responses that per se would not suffice to deal with those events)
(Crawford and Schuster 1993; Lancioni et al. 2001b, 2002a; Mechling 2006). For example, a
touch or pressure microswitch fixed to the armrest of a person's wheelchair and connected
to a timer and a music device may enable the person to activate such a device and listen
to music for brief periods of time (i.e., for periods such as those set in the timer) through
small hand- or arm-movement responses. Similarly, an optic microswitch fixed to an eye-
glasses' frame and connected to a timer and vibration devices may enable the person to
activate brief periods of vibratory stimulation through prolonged eyelid closure. A touch-
sensitive pad microswitch connected to the person's hand and linked to a timer and a
series of visual stimuli may enable the person to turn on these stimuli for brief periods of
time through minimal finger movements. None of the individuals involved in the exam-
ples described above would have been able to access the stimulation mentioned through a
direct manipulation of the stimulus sources (i.e., music device, vibration tools, and visual
displays or other forms of visual stimuli) (Lancioni et al. 2008b; Judge et al. 2010).
VOCAs (also known as speech-generating devices) are technical instruments that enable
a person with multiple disabilities to produce synthesized or digitized verbal messages/
requests through the performance of simple nonverbal responses (Schlosser and Sigafoos
2006; Lancioni et al. 2007a; Sigafoos et al. 2009; Valiquette et al. 2010). For example, the
person may have a pressure device before his or her hand connected to an electronic con-
trol system equipped with a speech output instrument. Each time he or she applies some
pressure on the device, this sends a signal to the electronic control system. This system in
turn activates the speech output instrument, which emits a call to the person's caregiver
to obtain attention and stimulation or to ask for his or her mediation in reaching specific
environmental stimuli (Schlosser and Sigafoos 2006; Rispoli et al. 2010).
This chapter is divided into four sections. The first section focuses on studies using exper-
imental microswitches developed to monitor small (nontypical) responses, such as eyelid
and lip movements, and thus to suit persons with minimal motor behavior (Lancioni and
Lems 2001; Lancioni et al. 2001c, 2009a, 2009b, 2010c). The second section analyzes studies
that have combined two or more microswitches to allow the person direct access to differ-
ent types of stimulation and choice opportunities (Sullivan et al. 1995; Lancioni et al. 2001,
2002a, 2006b, 2010a, 2010b). The third section reviews studies that have combined micro-
switches with VOCAs to allow the person direct access to stimulation as well as the possibil-
ity to call for social attention and interaction (Lancioni et al. 2008a, 2009f, 2010d). The fourth
section discusses (1) the results obtained with the different forms of technology used and
their applicability and possible impact in daily education/rehabilitation contexts, and (2) the
possibility of using combinations of microswitches also for programs aimed at targeting
increases of adaptive responding and reduction of problem behaviors or inadequate pos-
tures simultaneously. Table 18.1 lists relevant studies for each of the first three sections of the
paper. Most of those studies are also summarized in the review sections that follow below.
