Biomedical Engineering Reference
In-Depth Information
Results were largely encouraging. Each participant increased his responding with both
microswitches through the intervention periods.
Lancioni et al. (2010a) worked with a man of 21 years of age whose physical condition had
deteriorated markedly and the use of optic sensors fixed on support frames to monitor his
responses (i.e., eyelid opening and mouth opening) had become difficult and not always
reliable. The new camera-based microswitch technology (mentioned above) was used with
him to monitor the aforementioned eyelid and mouth responses. During sessions in which
mouth opening was targeted, the camera-based technology was used together with two
small color spots on the participant's nose and lower lip, respectively. When the camera
system recorded an increase in the distance between the two spots greater than a preset
level, a mouth-opening response was recorded. During sessions in which eyelid opening
was targeted, the camera-based technology was used together with a color spot on the left
eyelid. When the dimensions of the spot were smaller than a preset level, the camera sys-
tem recorded an eyelid-opening response. During sessions in which both responses were
targeted, the camera-based technology was used in combination with the dots on the nose
and lip as well as the spot on the eyelid. Each response (camera-technology activation)
allowed access to brief stimulation events. The events differed for the two responses. Data
showed a successful use of the technology with the frequency of both responses increas-
ing widely during the intervention program.
18.4 Combinations of Microswitches and VOCAs
The successful use of single and multiple microswitches can be considered strong evi-
dence in support of the effectiveness of these technological resources. Indeed, they may be
instrumental to allow persons with severe/profound multiple disabilities opportunities
of positive engagement, independent stimulation access, and choice. Microswitch-based
programs may be seen as a critical component of any rehabilitation context for two main
reasons. First, they can be complementary to the direct intervention of rehabilitation and
care staff. In fact, these people cannot be expected to guarantee a consistent/continuous
educational presence (Lancioni et al. 2008b). Second, they can be instrumental to help
the participants develop forms of activity and independence through the acquisition of
specific responses (Holburn et al. 2004; Lancioni et al. 2008b). The recognition of these
extremely important functions may not totally eliminate a sense of caution about these
programs. Such caution stems from the knowledge that they promote the person's access
to environmental (nonhuman) stimuli but largely ignore any possible desires of the person
for contact with the caregiver.
Caution would seem to be more realistically required when the implementation of these
programs involves the use of relatively long sessions and/or a large number of sessions
during the day. In those situations (and probably in less concerning ones as well), a reas-
suring approach might consist of supplementing conventional microswitch technology
with a VOCA. The microswitch technology would ensure that the participant continues
to independently access environmental stimuli. The VOCA would enable the participant
to ask for caregiver contact whenever he or she desires to have such a contact. Table 18.1
provides a list of eight studies that have combined microswitch and VOCA devices to
accommodate participants' desires and caregivers' duties. Specifically, those studies have
(1) sought to provide the participants a wider range of occupational opportunities as well
 
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