Publications by authors named "Giulio Lancioni"

285 Publications

Use of technology to sustain mobility in older people with cognitive impairment and dementia: a scoping review.

Disabil Rehabil Assist Technol 2021 Mar 22:1-15. Epub 2021 Mar 22.

Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy.

Purpose: This paper provides a review of studies that evaluated technology devices to sustain various forms of mobility in older people with cognitive impairment or dementia and mobility problems (e.g., inability to ambulate or difficulties to orient with consequent failures to reach relevant destinations).

Methods: A literature search was performed for English language articles indexed in PubMed, PsycINFO, and Web of Science. This search was then supplemented with an ancestral and forward search. The search covered the period ranging between January 2010 and October 2020.

Results: Twenty-seven articles were included in the review. They were divided into four groups according to whether they aimed to promote (a) supported ambulation, (b) use of safe power wheelchair, (c) ambulation guided by orientation cues, and (d) ambulation with GPS-based assistance. The studies were coded in terms of the objective pursued, technology used, participants involved, strategies applied to assess the technology, and outcome reported.

Conclusion: A variety of technology devices are available to address the mobility problems of older people with cognitive impairment or dementia. The devices' accessibility and usability differ widely. Data on their impact are still largely preliminary and new systematic research is needed.IMPLICATIONS FOR REHABILITATIONA variety of mobility problems may afflict older people with cognitive impairment or dementia and curtail their opportunities to freely move indoor or outdoor.Technology devices have been developed to (a) promote forms of supported ambulation, (b) facilitate safe use of power wheelchairs, (c) deliver orientation/navigation cues, and (d) ensure tracking and possible assistance.The technology devices differ in terms of accessibility and affordability, with some of them readily available and others at a developmental stage.Data on the effectiveness of the various technology devices in reducing the impact of the mobility problems are still largely preliminary and new systematic research is needed.
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http://dx.doi.org/10.1080/17483107.2021.1900935DOI Listing
March 2021

Use of technology to sustain mobility in older people with cognitive impairment and dementia: a scoping review.

Disabil Rehabil Assist Technol 2021 Mar 22:1-15. Epub 2021 Mar 22.

Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy.

Purpose: This paper provides a review of studies that evaluated technology devices to sustain various forms of mobility in older people with cognitive impairment or dementia and mobility problems (e.g., inability to ambulate or difficulties to orient with consequent failures to reach relevant destinations).

Methods: A literature search was performed for English language articles indexed in PubMed, PsycINFO, and Web of Science. This search was then supplemented with an ancestral and forward search. The search covered the period ranging between January 2010 and October 2020.

Results: Twenty-seven articles were included in the review. They were divided into four groups according to whether they aimed to promote (a) supported ambulation, (b) use of safe power wheelchair, (c) ambulation guided by orientation cues, and (d) ambulation with GPS-based assistance. The studies were coded in terms of the objective pursued, technology used, participants involved, strategies applied to assess the technology, and outcome reported.

Conclusion: A variety of technology devices are available to address the mobility problems of older people with cognitive impairment or dementia. The devices' accessibility and usability differ widely. Data on their impact are still largely preliminary and new systematic research is needed.IMPLICATIONS FOR REHABILITATIONA variety of mobility problems may afflict older people with cognitive impairment or dementia and curtail their opportunities to freely move indoor or outdoor.Technology devices have been developed to (a) promote forms of supported ambulation, (b) facilitate safe use of power wheelchairs, (c) deliver orientation/navigation cues, and (d) ensure tracking and possible assistance.The technology devices differ in terms of accessibility and affordability, with some of them readily available and others at a developmental stage.Data on the effectiveness of the various technology devices in reducing the impact of the mobility problems are still largely preliminary and new systematic research is needed.
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http://dx.doi.org/10.1080/17483107.2021.1900935DOI Listing
March 2021

People with intellectual and visual disabilities access basic leisure and communication using a smartphone's Google Assistant and voice recording devices.

Disabil Rehabil Assist Technol 2020 Oct 20:1-8. Epub 2020 Oct 20.

Department of Psychology, University of Bologna, Bologna, Italy.

Purpose: This study assessed a new technology system to help six participants with intellectual and visual disabilities manage leisure engagement and communication with distant partners in an independent manner.

Methods: A nonconcurrent multiple baseline design across participants was used to assess the effects of the new technology system. This included a Samsung Galaxy J4 Plus smartphone with Android 9.0 operating system, mini voice recording devices, and a Bluetooth speaker. The smartphone was provided with a Google account and Internet connection. The participants could activate the smartphone's Google Assistant and thus access leisure events, start telephone calls or send messages by triggering mini voice recording devices. Each device, when triggered, uttered a specific verbal request (i.e., a request for a leisure option or for a communication partner to call or to reach by messages). Messages received from those partners were read automatically by the smartphone.

Results: During baseline (when the voice recording devices were not available), the participants did not manage to activate the smartphone's Google Assistant and thus did not access leisure events and did not make telephone calls or send messages independently. During the post-intervention phase (when the voice recording devices were available), all participants accessed leisure events and made telephone calls or sent and received messages independently, remaining positively engaged throughout the 10-min sessions. Staff rated the new technology system positively.

Conclusion: The new technology system may be a useful resource to help people like the participants of this study access basic leisure and communication independently. Implications for rehabilitation A technology system relying on commercial devices may be practical and acceptable in daily programs for persons with intellectual and other disabilities. Such system may be used for supporting the persons' independent leisure engagement and communication with distant partners. A system may be accessible to persons with significant disabilities if the responses needed to operate it are simple. Simple hand-pressure responses may be sufficient to operate a system that relies on the input of mini voice recording devices.
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http://dx.doi.org/10.1080/17483107.2020.1836047DOI Listing
October 2020

Extended smartphone-aided program to sustain daily activities, communication and leisure in individuals with intellectual and sensory-motor disabilities.

Res Dev Disabil 2020 Oct 2;105:103722. Epub 2020 Jul 2.

Oasi Research Institute - IRCCS, Troina, Italy.

Background: Smartphone-aided programs were recently developed to support leisure engagement and communication with distant partners in individuals with special needs. This study evaluated an extended smartphone-aided program that supported daily activities in addition to communication and leisure in individuals with intellectual and visual or visuo-motor disabilities.

Method: Six participants were involved who had been exposed to an earlier smartphone-aided program supporting communication and leisure. The extended program (a) relied on the use of a Samsung Galaxy J4 Plus smartphone, which was fitted with Android 9.0 operating system and MacroDroid, and (b) alternated periods in which the participants could engage in communication and leisure with periods in which they were provided with instructions for daily activities.

Results: During the baseline (i.e., with the earlier smartphone-aided program), the participants engaged in communication and leisure, but did not start any activity. During the post-intervention phase (i.e., with the extended smartphone-aided program), the participants maintained successful communication and leisure engagement and started and carried out daily activities successfully. Staff rated the extended program largely preferable to the original program.

Conclusions: The extended program can be a useful tool for widening the functional occupation of individuals like the participants of this study.
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http://dx.doi.org/10.1016/j.ridd.2020.103722DOI Listing
October 2020

Mainstream technology to support basic communication and leisure in people with neurological disorders, motor impairment and lack of speech.

Brain Inj 2020 06 22;34(7):921-927. Epub 2020 May 22.

Don Carlo Gnocchi I.R.C.C.S ., Milan, Italy.

Objective: To assess a simple technology solution to support basic communication and leisure in people with neurological disorders, extensive motor impairment, and absence of speech.

Design: The design was a non-concurrent multiple baseline across participants.

Methods: The study included eight participants and assessed a technology setup including a Samsung Galaxy Tab S2 LTE tablet and a Samsung Galaxy A3 smartphone. The smartphone, automated via MacroDroid, presented the participant with leisure, messages, and caregiver options. Choosing leisure or messages (by activating the smartphone's proximity sensor) led the smartphone to present the alternatives available for that option and eventually verbalize the alternative selected. This verbalization triggered the tablet's Google Assistant and led the tablet to present a leisure event or start a message exchange. Choosing the caregiver led the smartphone to invite the caregiver to interact with the participant.

Results: During baseline (i.e., when a standard smartphone was available), the participants did not activate any of the options. During intervention and post-intervention (i.e., with the technology described above), participants activated all options and spent most of the session time positively engaged with them.

Conclusions: The aforementioned technology seems to be a useful tool for individuals like those involved in this study.
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http://dx.doi.org/10.1080/02699052.2020.1763462DOI Listing
June 2020

Comparative Effectiveness of Caregiver Training in Mindfulness-Based Positive Behavior Support (MBPBS) and Positive Behavior Support (PBS) in a Randomized Controlled Trial.

Mindfulness (N Y) 2020 30;11(1):99-111. Epub 2018 Jan 30.

8Institute of Mind Humanities, Wonkwang University, Iksan, South Korea.

Caregivers of individuals with intellectual and developmental disabilities are often stressed due to the demands of the job, including the nature and severity of challenging behaviors of the clients, work conditions, degree of management support for the staff, and the demands of implementing some interventions under adverse conditions. Mindfulness-Based Positive Behavior Support (MBPBS) and PBS alone have been shown to be effective in assisting caregivers to better manage the challenging behaviors of clients with intellectual and developmental disabilities. The aim of the present study was to undertake a head-to-head assessment of the effectiveness of MBPBS and PBS alone in a 40-week randomized controlled trial. Of the 123 caregivers who met inclusion criteria, 60 were randomly assigned to MBPBS and 63 to PBS alone, with 59 completing the trial in the MBPBS condition and 57 in the PBS alone condition. Results showed both interventions to be effective, but the caregiver, client, and agency outcomes for MBPBS were uniformly superior to those of PBS alone condition. In addition, the MBPBS training was substantially more cost-effective than the PBS alone training. The present results add to the evidence base for the effectiveness of MBPBS and, if independently replicated, could provide an integrative health care approach in the field of intellectual and developmental disabilities.
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http://dx.doi.org/10.1007/s12671-018-0895-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223775PMC
January 2018

A Component Analysis of the Mindfulness-Based Positive Behavior Support (MBPBS) Program for Mindful Parenting by Mothers of Children with Autism Spectrum Disorder.

Mindfulness (N Y) 2020 May 11:1-13. Epub 2020 May 11.

5WellStar School of Nursing, Kennesaw State University, Kennesaw, GA USA.

Objectives: Mindfulness-Based Positive Behavior Support (MBPBS) has been shown to be effective in reducing stress and burnout in parents and professional caregivers of children and adolescents with intellectual and developmental disabilities (IDD) and autism spectrum disorder (ASD). The aim of this study was to assess the comparative effects of the mindfulness (MB) and positive behavior support (PBS) components against the MBPBS program for mindful parenting.

Methods: The study utilized a three-arm randomized controlled trial design, with a 10-week pre-treatment control condition, 30 weeks of intervention, and 3 years of post-intervention follow-up. Mothers of children with ASD were randomly assigned to the MB, PBS, and MBPBS conditions and provided 3 days of training specific to each condition. The effects of these programs were assessed on the mothers (i.e., training attendance, meditation time, perceived psychological stress) and spillover effects were assessed on their children with ASD (i.e., aggression, disruptive behavior, compliance with mothers' requests).

Results: Mothers in the MBPBS condition reported greater reductions in perceived psychological stress, followed by those in the MB condition, and with no significant changes reported by those in the PBS condition. Reduction in the children's aggression and disruptive behavior followed a similar pattern, with most to least significant reductions being in MBPBS, MB, and PBS condition, respectively. Significant increases in compliance (i.e., responsiveness to mothers' requests) were largest in the MBPBS condition, followed by MB, and then PBS. Changes across all variables for both mothers and their children were maintained for 3 years post-intervention. After time and training type were controlled for, meditation time was a significant predictor in reducing aggressive and disruptive behaviors, and in enhancing compliance of the children with mothers' requests.

Conclusions: Positive outcomes for mothers and their children with ASD were significantly greater in the MBPBS condition, followed by the MB condition, and least in the PBS condition. MBPBS appears to be an effective mindful parenting program on the assessed variables.
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http://dx.doi.org/10.1007/s12671-020-01376-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223597PMC
May 2020

Everyday Technology to Support Leisure and Daily Activities in People with Intellectual and Other Disabilities.

Dev Neurorehabil 2020 Oct 2;23(7):431-438. Epub 2020 Mar 2.

Lega F. D'Oro Research Center , Osimo, Italy.

: The study evaluated a smartphone-aided program to support independent access to leisure events and performance of daily activities in seven participants with moderate intellectual disability, four of whom also had severe hearing loss. : The program relied on the use of a Samsung Galaxy J4 Plus smartphone with Android 9.0 operating system. The smartphone's functioning was automated via the MacroDroid application. The program was to allow the participants to alternate access to leisure events (delivered via the smartphone) with performance of vocational activities (guided through smartphone-delivered pictorial or pictorial and verbal instructions) over sessions of about 30 min. : During the baseline, the participants failed to access leisure events and perform scheduled activities independently. When the program was used, however, all participants succeeded in both accessing leisure events and performing activities independently. : The smartphone-aided program can be a useful tool for people like the participants of this study.
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http://dx.doi.org/10.1080/17518423.2020.1737590DOI Listing
October 2020

Basic smartphone-aided communication and leisure for people with extensive neuro-motor impairment and absence of speech.

NeuroRehabilitation 2019 ;45(3):311-322

Don Carlo Gnocchi I.R.C.C.S., Milan, Italy.

Background: Individuals with extensive neuro-motor impairment and lack of speech tend to remain passive and isolated, and to rely on others for communication and leisure. While their problems are known, only limited evidence is available about intervention tools that could help them curb those problems.

Objective: This study was aimed at upgrading and assessing a smartphone-based technology package, which was recently developed to help those individuals to independently engage in basic communication and leisure.

Methods: The study included 11 non-ambulatory participants who had no speech or functional active communication. They were provided with (a) a Samsung A3 smartphone with Android 6.0 Operating System, which was fitted with WhatsApp Messenger and programmed via MacroDroid, and (b) cards fitted with radio frequency identification (RFID) tags. By bringing those cards in contact with the back of the smartphone, the participant could start a communication event (e.g., sending a message to a friend) or activate a leisure event (e.g., a song). The smartphone would automatically read to the participant any incoming messages.

Results: During the baseline (i.e., when a standard smartphone was available), the participants were unable to engage in communication or leisure. Once the aforementioned technology package was introduced, the participants spent between about 65 and 85% of their session time engaging in communication and leisure.

Conclusions: The smartphone-based technology package seems to be a useful tool to support basic communication and leisure in individuals like those involved in this study.
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http://dx.doi.org/10.3233/NRE-192811DOI Listing
March 2020

Smartphone technology for fostering goal-directed ambulation and object use in people with moderate Alzheimer's disease.

Disabil Rehabil Assist Technol 2020 10 15;15(7):754-761. Epub 2019 Nov 15.

Alzheimer Center, Bisceglie, Italy.

This study was aimed at assessing a smartphone-based intervention to help 11 individuals with moderate Alzheimer's disease and ambulation problems to manage goal-directed, walker-assisted ambulation and object use (i.e., to reach specific destinations and put away objects at those destinations independently). The study was carried out according to a non-concurrent multiple baseline design across participants. Two measures were recorded, that is, the number of target responses performed correctly (with each target response consisting of reaching a destination and putting away an object), and the number of observation intervals with indices of enjoyment/appreciation (e.g., smiles and positive comments). During baseline, the participants were provided with a walker and three objects that were to be transported to and put away at specific destinations. During the intervention, the participants also had the smartphone-based technology that provided them with instructions about the destinations and objects, praise, and preferred stimulation. During baseline, the mean frequency of correct target responses was virtually zero. The mean frequency of intervals with indices of enjoyment/appreciation ranged from zero to close to one. During the intervention, the mean frequencies for the two measures were slightly below three and just over three, respectively. The maximum frequencies possible were three and four, respectively. A smartphone-based intervention may be suitable to foster goal-directed, walker-assisted ambulation and object use as well as enjoyment/appreciation in participants like those involved in this study.IMPLICATIONS FOR REHABILITATIONA smartphone-based intervention may be used to promote goal-directed, walker-assisted ambulation and object use as well as indices of enjoyment/appreciation in persons with moderate Alzheimer disease.The technology for such intervention might involve (a) a smartphone with Android operating system, light sensor, Bluetooth v4.0, and MacroDroid, (b) Bluetooth headphones or earpieces, and (c) battery-powered light sources.The technology may provide the participants with instructions about the destinations to reach and the objects to put away at those destinations, and with praise and brief periods of preferred stimulation at the target destinations.The technology may be considered easy to access, friendly for the participants, and suitable for use by staff within daily contexts.
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http://dx.doi.org/10.1080/17483107.2019.1686075DOI Listing
October 2020

Introduction to the special section on an assistive technology selection framework.

Disabil Rehabil Assist Technol 2019 11 13;14(8):752. Epub 2019 Sep 13.

University of Bari, Italy.

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http://dx.doi.org/10.1080/17483107.2019.1664077DOI Listing
November 2019

Towards a consensus on developmental regression.

Neurosci Biobehav Rev 2019 12 20;107:3-5. Epub 2019 Aug 20.

Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany; iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria; Leibniz ScienceCampus Primate Cognition, Goettingen, Germany; Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Electronic address:

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http://dx.doi.org/10.1016/j.neubiorev.2019.08.014DOI Listing
December 2019

Recent Technology-Aided Programs to Support Adaptive Responses, Functional Activities, and Leisure and Communication in People With Significant Disabilities.

Front Neurol 2019 2;10:643. Epub 2019 Jul 2.

Lega F. Doro Research Center, Osimo, Italy.

This paper presents an overview of recent technology-aided programs (i. e., technology-aided support tools) designed to help people with significant disabilities (a) engage in adaptive responses, functional activities, and leisure and communication, and thus (b) interact with their physical and social environment and improve their performance/achievement. In order to illustrate the support tools, the paper provides an overview of recent studies aimed at developing and assessing those tools. The paper also examines the tools' accessibility and usability, and comments on possible ways of modifying and advancing them to improve their impact. The tools taken into consideration concern, among others, (a) microswitches linked to computer systems, and aimed at promoting (i.e., through positive stimulation) minimal responses or functional body movements in individuals with intellectual disabilities and motor impairments; (b) computer systems, tablets, or smartphones aimed at supporting functional activity engagement of individuals with intellectual disabilities or Alzheimer's disease; and (c) microswitches with computer-aided systems, elaborate communication devices, and specifically arranged smartphones or tablets, directed at promoting leisure, communication, or both.
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http://dx.doi.org/10.3389/fneur.2019.00643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614206PMC
July 2019

Using a Textual Prompt to Teach Multiword Requesting to Two Children With Autism Spectrum Disorder.

Behav Modif 2019 11 21;43(6):819-840. Epub 2019 May 21.

5 University Medical Center Göttingen, Germany.

Autism spectrum disorder is characterized by social and communication impairment, but some children appear to have relative strength in areas such as reading printed words. The present study involved two children with limited expressive communication skills, but relatively stronger reading ability. Based on this existing strength, we evaluated a textual prompting procedure for teaching the children to produce multiword spoken requests. The effect of providing textual prompts on production of multiword requests was evaluated in an ABAB design. The results showed that multiword requests increased when textual prompts were provided and decreased when the prompts were removed. In subsequent phases, the textual prompts were successfully faded by gradually making the printed text lighter and lighter until eventually the prompts were eliminated altogether. We conclude that identification of children's strengths may assist in identifying effective prompting procedures that could then be used in teaching functional communication skills.
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http://dx.doi.org/10.1177/0145445519850745DOI Listing
November 2019

A Program Based on Common Technology to Support Communication Exchanges and Leisure in People With Intellectual and Other Disabilities.

Behav Modif 2019 11 20;43(6):879-897. Epub 2019 May 20.

5 OSMAIRM Rehabilitation Center, Laterza, Italy.

The aim of this study was to assess a new smartphone-based program version to allow seven participants with intellectual plus visual and/or motor disabilities and hesitant speech to send out and receive WhatsApp messages, make telephone calls, and access leisure activities. This program version relied on a Samsung A3 smartphone, which was automated through the MacroDroid application and responded to the input of specific cards and miniature objects. During the baseline (i.e., without the program), the participants' performance was zero or close to zero on communication and leisure. During the use of the program, the participants increased their frequency of WhatsApp messages sent out and received/listened to, and of leisure activities accessed. Their frequency of telephone calls averaged between virtually zero and slightly above one. The implications of the findings are discussed in relation to the technology used for the program and the applicability of the program in daily contexts.
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http://dx.doi.org/10.1177/0145445519850747DOI Listing
November 2019

Smartphone-Based Interventions to Foster Simple Activity and Personal Satisfaction in People With Advanced Alzheimer's Disease.

Am J Alzheimers Dis Other Demen 2019 Nov-Dec;34(7-8):478-485. Epub 2019 Apr 23.

Alzheimer Center, Bisceglie, Italy.

Objectives: This study assessed a smartphone-based program to promote practical and mildly demanding arm responses and personal satisfaction and increase physical exertion (heart rates) in people with advanced Alzheimer's disease.

Methods: The program relied on a Samsung Galaxy A3 smartphone with Android 6.0 operating system. Two groups of 10 and 11 participants, respectively, were assigned different responses (ie, placing cards into an elevated box and moving bottles with water from a table into a container). Responses activated the smartphone, which produced brief periods of preferred stimulation. Lack of responding led the smartphone to produce a verbal prompt.

Results: All participants had significant increases in independent response frequencies, level of personal satisfaction, and heart rates during program sessions as opposed to baseline or control sessions.

Conclusion: A smartphone-based program may help people with advanced Alzheimer's disease increase independent occupation with possible benefits in terms of satisfaction and physical condition.
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http://dx.doi.org/10.1177/1533317519844144DOI Listing
July 2020

Effects of Mindfulness-Based Positive Behavior Support (MBPBS) Training Are Equally Beneficial for Mothers and Their Children With Autism Spectrum Disorder or With Intellectual Disabilities.

Front Psychol 2019 6;10:385. Epub 2019 Mar 6.

Numata Center for Buddhist Studies, University of Hamburg, Hamburg, Germany.

Parenting a child with autism spectrum disorder (ASD) or intellectual disabilities (IDs) can be stressful for many parents. Mindfulness-Based Positive Behavior Support (MBPBS) is a customized mindfulness program that enables parents and other caregivers to reduce their perceived psychological stress to normative levels through mindfulness procedures and to support children with ASD or ID to self-manage their challenging behaviors through positive behavior support (PBS). In this study, we evaluated whether MBPBS would have differential effects on the stress levels of mothers of adolescents with ASD ( = 47) or with ID ( = 45) and the effects of the program on the aggressive, disruptive, and compliance behaviors of their children. Both groups of mothers participated in the 40-week study (10 weeks control and 30 weeks MBPBS program), rated their own stress levels, and collected daily observational data on the adolescents' behavior. Results showed significant reductions in the level of stress in both groups of mothers, but no differential effects on mothers of children with ASD or with ID. In addition, significant reductions in aggression and disruptive behavior and increases in compliance behaviors were observed in the adolescents in both groups. The results suggest that MBPBS is equally beneficial for mothers of adolescents with ASD or ID. In the present study, although the mothers of children with ID had slightly higher levels of stress at baseline and mothers of children with ASD had lower levels of stress following the MBPBS program, the program can be considered equally effective in reducing the stress levels of both groups of mothers. This suggests that the program may be effective regardless of baseline levels of mothers' stress.
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http://dx.doi.org/10.3389/fpsyg.2019.00385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414461PMC
March 2019

Addressing sequelae of developmental regression associated with developmental disabilities: A systematic review of behavioral and educational intervention studies.

Neurosci Biobehav Rev 2019 01 24;96:56-71. Epub 2018 Nov 24.

Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany; iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria. Electronic address:

Developmental regression is characteristic of Rett syndrome and it also occurs in a number of other developmental disabilities. To assist clinicians in identifying promising therapeutic approaches, we identified 38 studies that sought to improve adaptive behavior functioning in cases where developmental regression had either already occurred or was likely to occur. Studies were summarized in terms of (a) participants, (b) intervention, (c) dependent variables, (d) outcomes, (e) study design, and (f) certainty of evidence. The available literature included 136 participants from preschoolers to adults. Most participants (n = 132) had Rett syndrome. Interventions targeted a range of dependent variables (e.g., challenging behavior, communication, motor, and play skills). Multi-component interventions derived from behavior analytic principles were the norm, suggesting the need for clinical expertise in the application of such principles. However, only 12 studies (with 44 participants) were rated as providing conclusive evidence of a positive intervention effect. Future research on the mechanisms underlying developmental regression might lead to new and more effective interventions.
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http://dx.doi.org/10.1016/j.neubiorev.2018.11.014DOI Listing
January 2019

Technology-aided leisure and communication support in extensive neuro-motor and communication impairments.

Eur J Phys Rehabil Med 2019 Oct 29;55(5):682-686. Epub 2018 Oct 29.

Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy.

Background: Individuals with extensive neuro-motor impairment and lack of speech are known to remain fairly isolated and rely on others. Yet, there is only limited evidence as to how one can help them to reach a level of independence in relevant areas such as leisure and communication. This study assessed a program based on everyday technology to support leisure and communication engagement in six of those individuals.

Case Report: The six cases (adults) were non-ambulatory and had no speech or functional active communication. Their neurological damage was due to extensive left hemispheric hemorrhagic or ischemic lesion and to critical illness polyneuropathy aggravating a condition of neonatal encephalopathy. A smartphone-based program was developed and successfully used to enable them to access leisure activities (e.g., listening to music) and communication (e.g., sending text messages or calling the caregiver).

Clinical Rehabilitation Impact: Cases like those presented in this study may reach independent and functional engagement if supported via specific, technology-aided intervention programs.
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http://dx.doi.org/10.23736/S1973-9087.18.05521-1DOI Listing
October 2019

Should Heritage Languages be Incorporated into Interventions for Bilingual Individuals with Neurodevelopmental Disorders? A Systematic Review.

J Autism Dev Disord 2019 Mar;49(3):887-912

Università degli studi di Bari Aldo Moro, Bari, Italy.

Special education policies recognize the need for developing and preserving the heritage languages of individuals with disabilities. Yet there seems to be a disconnect between policy and practice. Should the heritage languages of bilingual individuals with neurodevelopmental disorders be incorporated into interventions? This review evaluated 18 studies that examined the effects of heritage language instruction on treatment outcomes for individuals with neurodevelopmental disorders. Overall, results suggest a small effect favoring interventions delivered in the heritage language versus interventions delivered solely in the majority language. In general, studies were also found to be of high-quality according to What Works Clearinghouse Standards. Findings are discussed in terms of recommendations for future research and practice.
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http://dx.doi.org/10.1007/s10803-018-3790-8DOI Listing
March 2019

A tablet-based program to enable people with intellectual and other disabilities to access leisure activities and video calls.

Disabil Rehabil Assist Technol 2020 01 11;15(1):14-20. Epub 2018 Oct 11.

OSMAIRM Rehabilitation Center, Laterza, Italy.

This study evaluated a tablet-based program to help eight participants with moderate intellectual disability, sensory and/or motor impairments, and lack of expressive or expressive and receptive verbal skills to select and access leisure activities and video calls independently. The program relied on the use of a tablet (i.e., Samsung Galaxy Tab S2 LTE) with 8-inch screen, Android 6.0 Operating System, front camera, proximity sensor and multimedia player. The tablet was fitted with a SIM card and two specific applications, that is, WhatsApp Messenger for making video calls and MacroDroid for automating the tablet's functioning in accordance with the program conditions. The tablet presented pictures concerning leisure activities and preferred partners for video calls. The participant could select any activity or partner by touching (or nearing his or her hand to) the tablet's proximity sensor. During the baseline (i.e., without the program), the participants failed to access leisure activities or video calls. During the post-intervention phase (i.e., with the program), they selected and accessed those activities and calls independently and spent between about 75% and 90% of the session time engaging with them. The tablet-based program can be highly beneficial for people like the participants of this study.Implications for rehabilitationA technology-aided program may enable persons with intellectual and other disabilities to independently access leisure activities and communication with distant partners.The program may involve the use of video calls to allow communication to participants with limited or no verbal skills.The program may be realized using a tablet (a) including Android 6.0 Operating System, proximity sensor, and multimedia player, and (b) fitted with a SIM card and applications such as WhatsApp Messenger and MacroDroid.The program may be easily adapted to the participants' characteristics in terms of activities available and partners to reach.
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http://dx.doi.org/10.1080/17483107.2018.1508515DOI Listing
January 2020

An Upgraded Smartphone-Based Program for Leisure and Communication of People With Intellectual and Other Disabilities.

Front Public Health 2018 28;6:234. Epub 2018 Aug 28.

Oasi Research Institute - IRCCS, Troina, Italy.

People with intellectual disability and sensory or sensory-motor impairments may display serious problems in managing functional daily activities as well as leisure activities and communication with distant partners. The study assessed an upgraded smartphone-based program to foster independent leisure and communication activity of eight participants with mild to moderate intellectual disability, sensory or sensory-motor impairments, and limited speech skills. The upgraded program was based on the use of (a) a Samsung Galaxy A3 smartphone with Android 6.0 Operating System, near-field communication, music and video player functions, and Macrodroid application, and (b) special radio frequency-code labels. Participants requested leisure and communication activities by placing mini objects or pictures representing those activities and containing frequency-code labels on the smartphone. The smartphone, via the Macrodroid application, read the labels (i.e., discriminated the participants' requests) and provided the participants with the activities requested. During the baseline (i.e., in the absence of the program), the participants failed to request/access leisure and communication activities independently. During the post-intervention phase of the study (i.e., using the program), they succeeded in requesting/accessing those activities independently and spent about 70-90% of their session time busy with those activities. The upgraded smartphone-based program may be highly functional for people like the participants of this study.
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http://dx.doi.org/10.3389/fpubh.2018.00234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122188PMC
August 2018

Promoting physical activity in people with intellectual and multiple disabilities through a basic technology-aided program.

J Intellect Disabil 2018 Jun 21;22(2):113-124. Epub 2016 Dec 21.

Lega F. D'Oro Research Center, Italy.

This study assessed a technology-aided program (monitoring responding, and ensuring preferred stimulation and encouragements) for promoting physical activity with 11 participants with severe/profound intellectual and multiple disabilities. Each participant was provided with an exercise device (e.g. a static bicycle and a stepper) and exposed to the program according to an ABAB design, in which A and B represented baseline and intervention phases, respectively. Data recording concerned (a) the participants' responses with the exercise device (e.g. pedaling) during baseline and intervention phases and (b) their heart rates during the last intervention phase. The results showed that all participants had significant increases in responding with the exercise devices during the intervention phases. Heart-rate values during the intervention sessions indicated that the participants' responding during those sessions mostly amounted to moderate-intensity physical activity, with potential benefits for their overall physical condition. Implications of the findings and questions for future research in the area were discussed.
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http://dx.doi.org/10.1177/1744629516684986DOI Listing
June 2018

Technology-Based Behavioral Interventions for Daily Activities and Supported Ambulation in People With Alzheimer's Disease.

Am J Alzheimers Dis Other Demen 2018 08 9;33(5):318-326. Epub 2018 May 9.

7 Alzheimer Center, Bisceglie, Italy.

Objectives: These 2 studies evaluated technology-based behavioral interventions for promoting daily activities and supported ambulation in people with mild-to-moderate and moderate-to-severe Alzheimer's disease, respectively.

Methods: Study 1 included 8 participants who were taught to start and carry out daily activities on their own using a tablet or smartphone device, which provided activity reminders, step instructions, and praise. Study 2 included 9 participants who were taught to engage in brief periods of ambulation using a walker combined with a tilt microswitch and a notebook computer, which monitored step responses and provided stimulation and prompts.

Results: The participants of study 1 succeeded in starting the activities independently and carrying them out accurately. The participants of study 2 largely increased their ambulation levels and also showed signs of positive involvement (eg, smiles and verbalizations).

Conclusion: The aforementioned technology-based interventions may represent practical means for supporting people with Alzheimer's disease.
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http://dx.doi.org/10.1177/1533317518775038DOI Listing
August 2018

Understanding the Linguistic Needs of Diverse Individuals with Autism Spectrum Disorder: Some Comments on the Research Literature and Suggestions for Clinicians.

J Autism Dev Disord 2018 08;48(8):2890-2895

Università degli studi di Bari Aldo Moro, Bari, Italy.

The practice of advising bilingual parents of children with autism spectrum disorder (ASD) to speak in a single language, often the majority language of the region, with their child with ASD seems to be common. Such advice, however, is not grounded on empirical evidence but appears to be based more on logical arguments and assumptions. In this commentary, fears surrounding dual language exposure and empirical evidence supporting bilingualism in children with ASD are discussed. Suggestions for future research and three key steps that clinicians can consider taking to better address the needs of diverse learners are provided.
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http://dx.doi.org/10.1007/s10803-018-3532-yDOI Listing
August 2018

A Technology-Aided Program to Support Basic Occupational Engagement and Mobility in Persons with Multiple Disabilities.

Front Public Health 2017 11;5:338. Epub 2017 Dec 11.

Lega F. D'Oro Research Center, Osimo, Italy.

Background: Persons with severe/profound intellectual and multiple disabilities tend to be passive and sedentary. Promoting their occupational engagement and mobility (i.e., indoor walking) can help to modify their condition and improve their environmental input, health, and social image.

Aim: This study assessed whether a technology-aided program was suitable to (a) support independent occupation and mobility in eight participants with intellectual and sensory disabilities and (b) eventually increase the participants' heart rates to levels considered beneficial for them.

Method: The program, which involved a computer system regulating the presentation of auditory or visual cues and the delivery of preferred stimulation, was introduced according to a non-concurrent multiple baseline design across participants. The auditory or visual cues guided the participants to collect objects from different desks and to transport them to a final destination (i.e., depositing them into a carton). Preferred stimulation was available to the participants for collecting and for depositing the objects.

Results: During the program, all participants had an increase in their independent responses of collecting objects and transporting them to the final destination. Their heart rates also increased to levels reflecting moderate-intensity physical exercise, potentially beneficial for their health.

Conclusion: A program, such as that used in this study, can promote occupational engagement and mobility in persons with multiple disabilities.
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http://dx.doi.org/10.3389/fpubh.2017.00338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732144PMC
December 2017

Using Smartphones to Help People with Intellectual and Sensory Disabilities Perform Daily Activities.

Front Public Health 2017 24;5:282. Epub 2017 Oct 24.

Lega F. D'Oro Research Center, Osimo, Italy.

Background: People with mild-to-moderate intellectual disability and sensory impairments often fail to take initiative in starting and carrying out daily activities, with negative consequences for their occupational condition and social status. Their failure seems due to their inability to determine the right time for the activities and to remember all the activity steps.

Aim: This study assessed a smartphone intervention, which was designed to help eight participants (four presenting with intellectual disability and blindness and four presenting with intellectual disability and hearing impairment) to independently start and carry out daily activities at appropriate times.

Method: The intervention was introduced according to a non-concurrent multiple baseline design across participants. During the intervention, each participant was provided with a smartphone, which was fitted with the time schedule of his or her activities and the verbal or pictorial instructions for the single steps of those activities. When the time for an activity was reached, the participant was automatically reminded to start that activity and, thereafter, he or she was presented with the instructions for it.

Results: The use of the smartphone intervention promoted great improvement over the baseline for all participants. That is, the participants managed to (a) independently start the activities at the scheduled times and (b) carry out those activities with high levels of accuracy.

Conclusion: A smartphone intervention, such as that used in this study, may help people with mild-to-moderate intellectual disability and sensory impairments to successfully engage in daily activities.
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http://dx.doi.org/10.3389/fpubh.2017.00282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660726PMC
October 2017

Training Direct-Care Staff to Provide Communication Intervention to Adults With Intellectual Disability: A Systematic Review.

Am J Speech Lang Pathol 2017 Nov;26(4):1279-1295

School of Education, Victoria University of Wellington, New Zealand.

Purpose: The aim of this review was to summarize and evaluate studies on training direct-care staff to provide communication intervention to adults with intellectual disability.

Method: Systematic searches identified 22 studies. These were summarized and evaluated in terms of (a) participants; (b) settings; (c) training aims and procedures; (d) research designs; (e) reliability, integrity, and social validity; (f) outcomes; (g) generalization and follow-up; and (h) certainty of evidence.

Results: A total of 437 staff and 254+ adults with intellectual disability participated. Staff training most frequently involved combinations of verbal instruction, role play, modeling, practice, and feedback. Reliability was assessed in 18 studies with acceptable standards for most of these studies. Treatment integrity and social validity were assessed in 1 and 3 studies, respectively, with positive outcomes. Generalization and maintenance were assessed in 5 and 8 studies, respectively, with predominantly positive outcomes. Most studies reported positive outcomes for staff and positive or mixed outcomes for the adults with intellectual disability. Certainty of evidence was rated as conclusive in 1 study, suggestive in 14 studies, and inconclusive in 7 studies.

Conclusions: There is sufficient evidence to conclude that direct-care staff can be taught to provide effective communication intervention to adults with intellectual disability. Professionals involved in providing training and support to direct-care staff could expect positive outcomes from multicomponent training programs that include opportunities for practice and feedback.
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http://dx.doi.org/10.1044/2017_AJSLP-16-0125DOI Listing
November 2017

Promoting Functional Activity Engagement in People with Multiple Disabilities through the Use of Microswitch-Aided Programs.

Front Public Health 2017 10;5:205. Epub 2017 Aug 10.

Lega F. D'Oro Research Center, Osimo, Italy.

Background: People with severe/profound multiple (e.g., intellectual, motor, or sensory-motor) disabilities are frequently restricted to a situation of inactivity and dependence, which may be modified by promoting functional activity engagement through assistive technology.

Methods: This study assessed the possibility of promoting functional activity engagement microswitch-aided programs with nine participants with multiple disabilities between 10 and 29 years of age. Functional activity consisted of constructive interaction with the immediate environment (e.g., reaching/touching or putting away objects) through the use of response schemes considered practical and beneficial for the participants' physical exercise and general condition. Microswitch-aided programs were used to monitor the participants' responses and to automatically provide stimulation opportunities contingent on those responses.

Results: All participants had a large/significant increase in their activity engagement (i.e., response frequencies) during the microswitch-aided programs, when compared to the baseline periods. These data, which are in line with previous findings in the area, indicate that the programs targeted activity and responses suitable for the participants and ensured contingent stimulation effective to motivate them.

Conclusion: People with severe/profound multiple disabilities can engage in functional activity with the help of microswitch-aided programs.
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http://dx.doi.org/10.3389/fpubh.2017.00205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554124PMC
August 2017

Spatial reorientation decline in aging: the combination of geometry and landmarks.

Aging Ment Health 2018 10 20;22(10):1372-1383. Epub 2017 Jul 20.

a Department of Educational Sciences, Psychology, Communication , University of Studies of Bari , Bari , Italy.

Objectives: The study is focused on the assessment of reorientation skills in a sample of community-dwelling elderly people, manipulating landmarks and geometric (layout) information.

Method: A neuropsychological assessment was administered to 286 elderly participants, divided into six groups (healthy controls, HC; four subgroups of participants with mild cognitive impairment, MCI; participants with probable dementia, Prob_D) and tested with the Virtual Reorientation Test (VReoT). VReoT manipulated different spatial cues: geometry and landmarks (proximal and distal).

Result: Compared with HC, participants with MCI and Prob_D showed to be impaired in tasks involving geometry, landmarks and a combination of them. Both single and multiple domain impairment in MCI had an impact on reorientation performance. Moreover, VReoT was marginally able to discriminate between amnesic and non-amnesic MCI. The occurrence of getting lost events seemed to be associated to learning of geometric information.

Conclusion: The associative strength between landmark and target plays an important role in affecting spatial orientation performance of cognitively impaired participants. Geometry significantly supports landmark information and becomes helpful with the increase of cognitive impairment which is linked to a decrement in landmark encoding. VReoT seems to represent a reliable evaluation supplement for spatial orientation deficits in prodromal stages of dementia.
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http://dx.doi.org/10.1080/13607863.2017.1354973DOI Listing
October 2018