Biomedical Engineering Reference
In-Depth Information
opportunities for multiple intervention programs, additional (new) responses as well as
response variations should be investigated to provide alternatives to those mentioned
above and thus allow a wider applicability of this approach (i.e., making it suitable also to
individuals who require a response different from those mentioned above). For example,
one could investigate the usability of prolonged eyelid closures for participants for whom
this type of response may be much more plausible than double blinks or upward looking
(see above). Prolonged closures could be detected through adapted versions of the optic-
microswitch technology used for the other eyelid responses or through the new camera-
based microswitch technology. Another new response that could be targeted concerns
small hand-opening movements. This response could be particularly suitable for partici-
pants who tend to have their hands closed (i.e., persons who keep their fingers against the
palm of their hand). The technical solutions to monitor this new response could include
(1) a modified version of the microswitch now used for hand-closure responses (with
the new microswitch version activated as the person decreases his or her pressure on
it or ends his her contact with it, and (2) the aforementioned camera-based microswitch
technology.
The possibility of using multiple responses through multiple microswitches can be
seen as an important enrichment in the application of microswitch-based programs. In
fact, multiple responses/microswitches allow a person to extend the forms and broaden
the amount of his or her activity engagement and to widen the range of sensory input
(preferred stimulation) obtainable. The availability of different types of stimuli (each
related to one specific response) may also have beneficial effects in terms of response
motivation while limiting the risks of stimulus satiation. In such a condition, the per-
son would be allowed to operate choices (thus satisfying his or her possible stimulus
preferences), to increase his or her level of enjoyment by exploiting the opportunities of
stimulus variation, and to modulate his performance also in terms of response comfort-
ableness (Stafford et al. 2002; Cannella et al. 2005). Choice, self-determination, stimulus
variation, and response comfortableness are critical elements (variables) that could eas-
ily promote a sense of personal fulfillment, improve the person's mood, and ultimately
enhance the person's quality of life (Green and Reid 1999; Algozzine et al. 2001; Kazdin
2001; Hoch et al. 2002; Ross and Oliver 2003; Lancioni et al. 2004c, 2006a; Dillon and
Carr 2007).
A potential drawback of programs involving multiple responses with multiple micro-
switches is that they do not include any provisions for (1) checking whether the person
has a desire to be in contact with the caregiver, and (2) satisfying such a possible desire.
However, acknowledging this potential drawback does not mean that most of the pro-
grams with multiple microswitches/responses are affected by it. In fact, such a drawback
may have an impact only in programs that include (1) participants who are accustomed
to and obviously enjoy social contact, and (2) caregivers who are able to integrate the pro-
vision of verbal attention or verbal and physical attention to requests of contact within
their daily work schedule. Whenever the aforementioned conditions (for participants and
caregivers) exist, one could avoid the drawback by transforming programs with mul-
tiple microswitches into programs with combinations of microswitches and VOCAs (cf.
Schlosser and Sigafoos 2006; Lancioni et al. 2008b; Sigafoos et al. 2009). The combination of
a VOCA for requesting caregiver attention or mediation with regular microswitches that
consent direct access to environmental stimuli may be considered a realistic and straight-
forward process. The studies reviewed earlier provide encouraging evidence with regard
to this point (e.g., Lancioni et al. 2008b, 2009b, 2010c). An intervention program based on
the use of microswitches and a VOCA can include fairly long and/or multiple sessions a
