Persons with Multiple Disabilities Choose Among Environmental Stimuli Using a Smile Response and a Technology–Aided Program

Recent studies with three persons with multiple disabilities have indicated that smile expressions can be used as functional choice responses (i.e., occurring in relation to samples of preferred stimuli to be selected and absent in relation to samples of non-preferred stimuli to be bypassed). The purpose of this study was to extend the evaluation of the smile response with two new participants (a girl and a woman) with multiple disabilities within a technology-aided choice program. The smile response was monitored through an optic microswitch pointing to the girl’s lower lip or across the area before the woman’s right cheekbone. The study started with a baseline phase during which the participants were to use a vocalization response to choose among the stimuli presented to them. The intervention phase with the smile response and optic microswitch was introduced according to a non-concurrent multiple baseline design across participants. The results showed that both participants used the smile response and optic microswitch to choose the preferred stimuli and abstained from using such response (i.e., from making choices) in relation to non-preferred stimuli. Implications of the results are discussed.     

Technology-Based Programs to Support Adaptive Responding and Reduce Hand Mouthing in Two Persons with Multiple Disabilities

These two single-case studies assessed the use of microswitch clusters to support adaptive responses and reduce problem behavior with two adults with multiple disabilities. Study I involved a man whose adaptive responses consisted of touching color shapes appearing on a computer screen in front of him and the problem behavior was hand mouthing. Study II involved a woman whose adaptive response consisted of using a napkin to wipe her mouth to reduce drooling effects. Her problem behavior, like for the man, was hand mouthing. Initially, the intervention focused on the adaptive responses, which were followed by preferred stimulation. Then the intervention was extended so that the stimulation for the adaptive responses would be interrupted if the problem behavior appeared during its occurrence. The data of the two studies suggest that the intervention was effective in helping the participants engage in consistent rates of adaptive responses and curb their problem behavior. These findings were analyzed in relation to the characteristics of the intervention approach and its practical implications.     

Microswitch clusters to enhance adaptive responses and head control: a programme extension for three children with multiple disabilities

Purpose. We assessed the possibility of extending adaptive responding and head control in three children with multiple disabilities through the use of microswitch clusters.

Method. The children had previously learned to perform an adaptive hand response and to control head position during that response. They were now taught one or two new adaptive responses (foot lifting, leg touching, or vocalization) and to combine such responses with appropriate head position. Microswitch clusters served to ensure that an adaptive response was followed by positive stimulation only if it was combined with appropriate head position.

Results. The results were positive with the children learning the new adaptive responses and combining them with appropriate head position. This performance was maintained during two- or three-month post-intervention checks. During these checks, the children were also successful in using the old adaptive hand response with appropriate head position.

Conclusions. The use of microswitch clusters was effective to extend the level of adaptive responding and enhance appropriate head position during this responding. This outcome, which indicates a successful technical replication and procedural extension of previous work in the area, has positive practical implications for educational and occupational programmes for children with multiple disabilities.     

Technology-assisted programmes to promote leisure engagement in persons with acquired brain injury and profound multiple disabilities: two case studies

OBJECTIVE. To evaluate technology-assisted programmes for enabling a woman and a man with brain injury and profound multiple disabilities to acquire leisure engagement. METHOD. The technology for the woman (Study I) involved a portable computer with mouse, a Clicker 4 software package, a touch/pressure microswitch, and an interface to connect the Clicker with the microswitch. This technology allowed the woman to choose with a simple hand response among four stimulus categories (e.g., watching a film and interacting with others), each of which included several alternatives. The technology for the man (Study II) involved a computer-based choice system that allowed him to select preferred songs through a microswitch-aided finger-movement response. RESULTS. Data showed that the two participants learned to use the technology available and selected among the stimulus events thus reaching positive leisure engagement. CONCLUSION. Technology-assisted programmes may provide persons with acquired brain injury and multiple disabilities leisure engagement opportunities.     

Persons with Multiple Disabilities Exercise Adaptive Head and Hand-Eye Responses Using Technology-Aided Programs: Two Single-Case Studies

The present single-case studies assessed the effectiveness of technology-aided programs to help two persons with multiple disabilities exercise adaptive response schemes independently. In Study I, exercise concerned head movements (i.e., head and neck posture/muscle control) by a 12-year-old girl who tended to keep her head turned/bent to her left. In Study II, exercise concerned touching one or two object cues on a computer monitor (i.e., a preliminary form of hand-eye coordination) by a 15-year-old boy. The technology involved microswitches to detect the occurrence of the target responses and a computer/control system to record their occurrences and activate preferred stimuli contingent on them. Results showed large increases in the responses targeted for each of the two participants during the intervention phases of the studies. The importance of using technology-aided programs as tools for enabling persons with profound and multiple disabilities to practice relevant responses independently was discussed.     

Microswitch clusters to enhance adaptive responses and head control: A programme extension for three children with multiple disabilities

Purpose.?We assessed the possibility of extending adaptive responding and head control in three children with multiple disabilities through the use of microswitch clusters.

Method.?The children had previously learned to perform an adaptive hand response and to control head position during that response. They were now taught one or two new adaptive responses (foot lifting, leg touching, or vocalization) and to combine such responses with appropriate head position. Microswitch clusters served to ensure that an adaptive response was followed by positive stimulation only if it was combined with appropriate head position.

Results.?The results were positive with the children learning the new adaptive responses and combining them with appropriate head position. This performance was maintained during two- or three-month post-intervention checks. During these checks, the children were also successful in using the old adaptive hand response with appropriate head position.

Conclusions.?The use of microswitch clusters was effective to extend the level of adaptive responding and enhance appropriate head position during this responding. This outcome, which indicates a successful technical replication and procedural extension of previous work in the area, has positive practical implications for educational and occupational programmes for children with multiple disabilities.     

Enabling Persons with Acquired Brain Injury and Multiple Disabilities to Choose among Environmental Stimuli and Request their Repetition via a Technology-assisted Program

This study replicated/extended a pilot investigation of a technology-assisted program to enable persons with acquired brain injury and neuro-motor and communication/consciousness impairments to choose among environmental stimuli and request their repetition whenever they so desired. The study included three adult participants. Within each session, 16 stimuli (12 preferred and 4 non-preferred) were planned for the participants. A computer system provided a reminder of each stimulus (i.e., a 4-s sample of the stimulus). During the intervention, participants’ responding (e.g., repeated eye blinking or prolonged eye closure) in relation to a reminder/sample activated a microswitch, which triggered the computer system to turn on the related stimulus for 20 s. Participants’ lack of responding led the computer system to proceed to the next stimulus sample of the sequence. When participants responded immediately after (i.e., within 6 s from) the end of a stimulus presentation, that stimulus was repeated. Intervention promoted response increases for all three participants. All of them asked for repetition of preferred stimuli and showed minimal responding in relation to non-preferred stimuli. Results were discussed in light of previous (pilot) data with the same program and in terms of their implications for rehabilitation initiatives.     

Technology-assisted programmes to promote leisure engagement in persons with acquired brain injury and profound multiple disabilities: two case studies

Objective.?To evaluate technology-assisted programmes for enabling a woman and a man with brain injury and profound multiple disabilities to acquire leisure engagement.

Method.?The technology for the woman (Study I) involved a portable computer with mouse, a Clicker 4 software package, a touch/pressure microswitch, and an interface to connect the Clicker with the microswitch. This technology allowed the woman to choose with a simple hand response among four stimulus categories (e.g., watching a film and interacting with others), each of which included several alternatives. The technology for the man (Study II) involved a computer-based choice system that allowed him to select preferred songs through a microswitch-aided finger-movement response.

Results.?Data showed that the two participants learned to use the technology available and selected among the stimulus events thus reaching positive leisure engagement.

Conclusion.?Technology-assisted programmes may provide persons with acquired brain injury and multiple disabilities leisure engagement opportunities.     

Technology-assisted Programs to Promote Mouth Drying and Reduce the Effects of Drooling with Two Persons with Developmental Disabilities

The purpose of this study was to replicate/extend the assessment of technology-assisted programs for helping persons with intellectual and multiple disabilities acquire mouth-drying responses to reduce the effects of drooling. Two participants (one adolescent and one adult) were involved. The first participant, who had pervasive motor disabilities, was taught to turn his head with his mouth and chin touching a spongy surface (and getting dry in the process). The second participant, who did not have specific motor disabilities, was taught to use a handkerchief to dry his mouth. For both participants, the mouth-drying responses were automatically followed by preferred stimulation. Results showed that both participants increased the frequency of their mouth-drying responses and reduced the effects of their drooling (chin wetness) through the intervention (B) phases of the ABAB design sequences. The results are discussed in terms of their support of previous data in the area and their practical implications.     

Evaluating a computer system used as a microswitch for word utterances of persons with multiple disabilities

PURPOSE: To assess the effectiveness of a computer system used as a microswitch for word utterances of two adults with multiple disabilities. The system combined a new control software programme with a commercially available speech recognition programme. METHOD: Nine word utterances were targeted for each participant. The participant's emission of those utterances triggered the occurrence of related (favourite) stimuli during the intervention and the post-intervention check. RESULTS: Intervention data showed that (1) the participants increased the frequencies of the target utterances and (2) the computer system recognized about 80% of those utterances correctly, providing the participants with high levels of favourite stimulation. The post-intervention check showed comparable data with both participants. CONCLUSIONS: The computer system proved an adequate microswitch for word utterances. Based on this evidence, microswitch programmes could be extended beyond the use of conventional motor responses.     

Frontal activations associated with accessing and evaluating information in working memory: an fMRI study

To investigate the involvement of frontal cortex in accessing and evaluating information in working memory, we used a variant of a Sternberg paradigm and compared brain activations between positive and negative responses (known to differentially tax access/evaluation processes). Participants remembered two trigrams in each trial and were then cued to discard one of them and maintain the other one as the target set. After a delay, a probe letter was presented and participants made decisions about whether or not it was in the target set. Several frontal areas--anterior cingulate (BA32), middle frontal gyrus (bilateral BA9, right BA10, and right BA46), and left inferior frontal gyrus (BA44/45)--showed increased activity when participants made correct negative responses relative to when they made correct positive responses. No areas activated significantly more for the positive responses than for the negative responses. It is suggested that the multiple frontal areas involved in the test phase of this task may reflect several component processes that underlie more general frontal functions.     

Evaluating a computer system used as a microswitch for word utterances of persons with multiple disabilities

Purpose: To assess the effectiveness of a computer system used as a microswitch for word utterances of two adults with multiple disabilities. The system combined a new control software programme with a commercially available speech recognition programme. Method: Nine word utterances were targeted for each participant. The participant's emission of those utterances triggered the occurrence of related (favourite) stimuli during the intervention and the post-intervention check. Results: Intervention data showed that (1) the participants increased the frequencies of the target utterances and (2) the computer system recognized about 80% of those utterances correctly, providing the participants with high levels of favourite stimulation. The post-intervention check showed comparable data with both participants. Conclusions: The computer system proved an adequate microswitch for word utterances. Based on this evidence, microswitch programmes could be extended beyond the use of conventional motor responses.     

Evaluating a computer system used as a microswitch for word utterances of persons with multiple disabilities

Purpose: To assess the effectiveness of a computer system used as a microswitch for word utterances of two adults with multiple disabilities. The system combined a new control software programme with a commercially available speech recognition programme. Method: Nine word utterances were targeted for each participant. The participant's emission of those utterances triggered the occurrence of related (favourite) stimuli during the intervention and the post-intervention check. Results: Intervention data showed that (1) the participants increased the frequencies of the target utterances and (2) the computer system recognized about 80% of those utterances correctly, providing the participants with high levels of favourite stimulation. The post-intervention check showed comparable data with both participants. Conclusions: The computer system proved an adequate microswitch for word utterances. Based on this evidence, microswitch programmes could be extended beyond the use of conventional motor responses.     

Extending the evaluation of novel microswitch technology for small responses in children with profound multiple disabilities

This study extended the evaluation of microswitch technology (i.e., a position sensor and an optic device), recently introduced for chin and eyelid responses, with two new participants with profound multiple disabilities. The participants were girls of 12.5 and 4.0 years of age who did not possess any specific response that they could profitably use in their environment. The study was conducted according to an ABAB design with a 3-week postintervention check. The results showed that both participants increased their level of responding during the intervention phases and postintervention check compared to the baseline phases. This positive outcome was discussed in terms of (a) the apparent suitability of the technology and responses used in the study, (b) the beneficial implications for the participants, and (c) new developments in the area.     

Ipsilateral motor pathway confirmed by combined brain mapping of a patient with hemiparetic stroke: a case report

This study investigated the motor control pathway using both functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) in a patient with left hemiparesis with an infarction on the posterior limb of the right internal capsule. fMRI was performed using the blood oxygen level-dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of hand grasp-release movements in 1-Hz cycles. TMS was performed using a butterfly coil; the intersection of the wings (center of the coil) was applied tangentially to the scalp 1.0 cm apart. Stimulation was performed at 100% of maximal output. Motor evoked potentials (MEPs) from both abductor pollicis brevis (APB) muscles were obtained simultaneously. fMRI showed that the unaffected (left) primary sensorimotor cortex (SM1) was activated by movements of the unaffected (right) hand. Conversely, the bilateral SM1 were activated by movements of the affected (left) hand. Brain mapping using TMS showed that ipsilateral MEPs were obtained at the affected (left) APB muscle when the unaffected (left) motor cortex was stimulated. We concluded that the ipsilateral motor pathway from the unaffected motor cortex to the affected hand was present in this patient.     

Hemispheric asymmetries in eye-hand coordination

Manual asymmetries in limb kinematics and eye-hand coordination have usually been attributed to differences in online processing capabilities between the left and the right cerebral hemisphere. In the present fMRI experiment, we examined in right handers the brain areas involved in eye-hand coordination with either the left or the right hand. Although temporal and spatial accuracy was equal for left- and right-hand movements, manual asymmetries were found in behavioral and neurophysiologic data, suggesting an asymmetric mode of control for left vs. right eye-hand coordination. For left eye-hand coordination, peak velocity and saccade completion occurred earlier than for the contralateral movements, suggesting that there was more time needed for homing-in on the target. When using the right hand, there was more activation in occipital areas. This might indicate a more intense visual processing or visualization of the target locations. When using the left hand, there was more activation in sensorimotor areas, frontal areas and cerebellum. This might point toward more processing effort. Left-hand movements may be considered as more difficult than right-hand movements by right-handed participants. Alternatively and more likely, these findings might reflect a difference in attention or resources attributed to different aspects of the tasks because of the different functional specializations of both hand/hemisphere systems.     

Using a microswitch for vocalization responses with persons with multiple disabilities

Purpose: This study was aimed at extending the evaluation of a special microswitch for vocalization responses with two persons with multiple disabilities.

Method: The study was carried out according to an ABAB sequence (with A representing baseline and B treatment) with one person, and an AB sequence with the other person. Activation of the microswitch during treatment produced favourite environmental stimulation.

Results and conclusions: The results showed that both persons had an increase in the frequencies of vocalization responses during treatment. The importance of using these (fairly simple) responses within intervention programmes and some methodological issues were discussed.     

A new verbal reports fMRI dichotic listening paradigm for studies of hemispheric asymmetry

Dichotic listening (DL) is one of the most frequently used paradigms to study hemispheric asymmetry and has been employed in several neuroimaging studies. The classic behavioral DL paradigm requires the subject to give a verbal response on each trial, which may cause image artifacts due to head movements when applied to an imaging environment. In order to avoid such artifacts most studies have used modified versions of the classic DL paradigm, where no verbal response is required. The purpose of the present study was to test a new DL paradigm, specifically developed for the fMRI environment, which is based on collecting verbal responses and thus being as close as possible to the classic DL behavioral task. By employing a sparse-sampling EPI acquisition schema we attempted to limit the negative impact of overt speech on image quality. A 5-s 'silent gap' allowed for stimulus presentation and collection of a verbal response to occur between subsequent image acquisitions and served as a high-pass filter that was optimized to detect activations of interest. Hence, the contribution of response-related activations to the measured signal was reduced. Twelve healthy volunteers (six males and six females) participated in the study. In order to obtain a measure of reliability, all participants went through the classic DL paradigm three times. The results, based on the estimation of the intraclass correlation coefficient, functional probability maps as well as on laterality maps, showed consistent activation in the right and left superior temporal gyrus, left middle temporal gyrus, and right inferior temporal gyrus, thus replicating previous results with visual display and motor response DL paradigms. It is concluded that an fMRI DL paradigm based on overt verbal responses is feasible and could have general implications for future fMRI studies of speech perception and product in general.     

Selective activation of a parietofrontal circuit during implicitly imagined prehension

It is generally held that motor imagery is the internal simulation of movements involving one's own body in the absence of overt execution. Consistent with this hypothesis, results from numerous functional neuroimaging studies indicate that motor imagery activates a large variety of motor-related brain regions. However, it is unclear precisely which of these areas are involved in motor imagery per se as opposed to other planning processes that do not involve movement simulation. In an attempt to resolve this issue, we employed event-related fMRI to separate activations related to hand preparation-a task component that does not demand imagining movements-from grip selection-a component previously shown to require the internal simulation of reaching movements. Our results show that in contrast to preparation of overt actions, preparation of either hand for covert movement simulation activates a large network of motor-related areas located primarily within the left cerebral and right cerebellar hemispheres. By contrast, imagined grip selection activates a distinct parietofrontal circuit that includes the bilateral dorsal premotor cortex, contralateral intraparietal sulcus, and right superior parietal lobule. Because these areas are highly consistent with the frontoparietal reach circuit identified in monkeys, we conclude that motor imagery involves action-specific motor representations computed in parietofrontal circuits.     

fMRI评价正常老年人腕关节被动运动下脑激活区

目的 用功能磁共振技术观察正常老年人双侧腕关节被动运动时脑区激活情况.方法 对30例正常的右利手老年受试者分别进行双侧腕关节被动运动的功能MR扫描,采用SPM2软件进行数据分析和脑功能区定位.结果 利手(右手)运动主要激活对侧感觉运动皮质、运动前区,双侧辅助运动区、后顶叶及同侧小脑;非利手运动时除激活上述脑区外,还激活了同侧运动感觉区和对侧小脑,且对侧运动前区、双侧辅助运动区和同侧小脑的激活体积明显大于利手腕关节运动.结论 被动运动依赖于大脑皮质和小脑等许多与运动相关的脑功能区的参与;与利手腕关节运动相比,非利手腕关节运动更依赖于对侧PMC、双侧SMA和同侧小脑等运动区.