Biomedical Engineering Reference
In-Depth Information
day without any risk of isolating the participant and preventing him or her from human
interactions.
18.5.3 Other relevant Procedural Aspects for Daily Programs
In dealing with persons with severe/profound multiple disabilities, one can find that the
lack of constructive engagement with the outside world is often combined with forms of
problem behavior, such as eye poking and hand mouthing, or problem (inadequate) pos-
ture such as head tilting (Lancioni et al. 2009d). In an attempt to deal with these situations,
one might resort to the use of microswitch clusters (i.e., a strategy not reviewed above).
Such a strategy relies on the use of two or more microswitches to monitor simultaneously
the positive/adaptive response that should be increased and the problem behavior/posture
that should be reduced. The technology to realize viable cluster solutions may be consid-
ered reasonably accessible both in terms of complexity and costs (see Lancioni et al. 2008b,
2008e). Initially, the cluster program focuses on increasing the adaptive response that leads
to preferred stimulation. Subsequently, the adaptive response allows access to preferred
stimulation only if it occurs in the absence of the problem behavior/posture. Moreover,
the stimulation following an adaptive response free from the problem behavior/posture
would last the scheduled time only if the problem behavior/posture does not appear dur-
ing that time period. One may argue that such a strategy represents a most constructive
and positive approach to help persons with severe/profound multiple disabilities improve
their performance and advance their development. In fact, the use of microswitch clusters
allows the intervention conditions for increasing adaptive responding and for reducing
problem behavior/posture to be integrated within the same program.
For example, Lancioni et al. (2007e) used microswitch clusters with two participants of 8
and 12 years of age to (1) increase adaptive responses, which consisted of forms of object
manipulation, and (2) reduce problem behavior, which consisted of hand or object mouth-
ing. The adaptive responses were monitored through a wobble-like microswitch or a vibra-
tion microswitch. The problem behavior was monitored through optic microswitches,
which were arranged in different ways for the two participants so as to suit their behav-
ioral expressions. Initially, the program ensured that the participants would obtain brief
periods of preferred stimulation for each of their object manipulation responses irrespec-
tive of whether these responses occurred in the presence or in the absence of the problem
behavior. Once the object manipulation responses had been strengthened, their emission
would produce positive stimulation only if free from the problem behavior. Moreover,
such stimulation would be interrupted prematurely if the problem behavior occurred dur-
ing its presentation. Both participants were able to increase the frequency of their adaptive
manipulation responses and to reduce their problem behavior to low levels.
Lancioni et al. (2008e) carried out a study that was aimed at extending the application
and evaluation of microswitch clusters to promote adaptive responding and curb inap-
propriate (unhealthy) postures. The study involved three participants of about 8-17 years
of age with multiple disabilities. The participants' adaptive responses concerned various
foot and hand movements. The inappropriate posture was head forward tilting. Initially,
the participants had access to a brief period of preferred stimulation after each adaptive
response (regardless of their posture). Subsequently, only the adaptive responses that
occurred in the absence of the inappropriate posture were followed by the stimulation
scheduled for them. The stimulation lasted the full period if the participant remained free
from the inappropriate posture through that time. Lack of posture control led to a prema-
ture interruption of the stimulation. Data showed that all three participants increased their
