A wheelchair user with visual and intellectual disabilities managing simple orientation technology for indoor travel.

Persons with profound visual impairments and other disabilities, such as neuromotor and intellectual disabilities, may encounter serious orientation and mobility problems even in familiar indoor environments, such as their homes (Joffee & Rikhye, 1991; Lancioni & Oliva, 1999; Lancioni et al., 2007, 2008; Uslan, Russell, & Weiner, 1988). Teaching these persons to develop maps of their daily environment, using miniature replicas of the areas or some landmarks as orientation cues, may be difficult (Emerson & Corn, 2006; Joffee, 1995; Lancioni et al., 2007; Martinsen, Tellevik, Elmerskog, & Storlilckken, 2007). The difficulty may be even greater when the persons are in wheelchairs and thus have limited opportunities to explore the surrounding space and related cues (Lancioni et al., 2007).

A potentially effective alternative to the aforementioned maps could be the use of orientation technology, specifically, orientation systems that rely on directional cues (Lancioni et al., 2007; Uslan et al., 1988). These systems are intended to guide or direct persons to their destinations without requiring spatial or travel abilities other than those of orienting to the sources that are providing cues (Lancioni et al., 2007, 2008).

Although such systems can be useful, efforts are needed to enhance their flexibility and simplicity so that they can more easily suit different environmental and personal situations (Scherer, Sax, Vanbiervliet, Cushman, & Scherer, 2005). Recently, we designed a system to be simpler than previous systems. It uses cues only at destinations (that is, a single sound source per destination) and involves a portable, electronic control device with keys to activate the cues at the sources or destinations. Two participants with multiple disabilities used the system successfully (Lancioni et al., 2008).

The current study assessed such a system with a wheelchair user, a woman, with minimal residual vision and a moderate intellectual disability. Contrary to the aforementioned participants, the wheelchair user described in this report could not efficiently find doors to rooms by following the walls of a room or corridor with her hand. Moreover, she could not discriminate and use the keys of the control device. To deal with these disadvantages, we marked the doors to rooms with orange lights and used a larger control device with wider keys for activating destinations. The keys for activating the destinations were covered with small (discriminated) objects representing the activities that were available at the destinations; these objects were encircled with light-emitting diodes. The diodes on a key remained illuminated until that key was selected.

METHOD

Participant

The participant (Gloria) was 27 years old and in a wheelchair, which she could slowly propel on her own, because of her spastic tetraparesis and hip problems. She also had optic nerve atrophy and minimal residual vision, so she could see objects at a distance of about 1 meter (approximately 3 feet) and light sources at a distance of about 2 meters (approximately 6.5 feet) (Morse, Teresi, Rosenthal, Holmes, & Yatzkan, 2004). She was rated as having a moderate intellectual disability with a verbal IQ score of 47 on the Wechsler Adult Intelligence Scale.

Gloria could understand and produce simple sentences about daily events and persons. Her age equivalent for daily living skills was lower than 3 years on the Vineland Adaptive Behavior Scales-Interview Edition (Sparrow, Balla, & Cicchetti, 1984). Gloria was known for her orientation problems and her reliance on staff for reaching relevant destinations within her daily environment. She lived at home with her parents and attended a day activity center, where she engaged in vocational activities such as assembling key holders and wool decorations, and in leisure activities. Approval for this study was granted by the Scientific and Ethics Committee of the Lega F. D'Oro, Osimo, Italy. Gloria had expressed interest in the study and agreed to participate, but was not capable of signing an informed consent form, so her parents did it for her in accordance with Italian law.

[FIGURE 1 OMITTED]

Settings

The activity center that Gloria typically frequented and a resource area were used as intervention and generalization settings, respectively (see Figure 1). The activity center consisted of three rooms and a corridor (an area of more than 85 square meters, or abut 102 square yards). Each room included two or three destinations, with familiar vocational and leisure activities available during the baseline and intervention sessions. The doors to the rooms were open and marked with orange lights (of 21 watts and 12 volts) displayed at their edges. The resource area included two rooms and a corridor of more than 75 square meters (about 90 square yards) and contained several activity destinations for use during the generalization sessions. The distances that Gloria typically traveled to reach destinations varied between 4 meters (about 13 feet) and 16 meters (about 52 feet).

[FIGURE 2 OMITTED]

Orientation system

The system included a sound source at each destination and an electronic control device. The sources were recording-playing boxes with radio receivers that emitted cues consisting of combinations of the participant's name with one or two other words (such as "Over here, Gloria"). The control device (a box that measured 32 x 20 x 5 centimeters, or about 13 x 8 x 1.9 inches), was on Gloria's legs, and it operated through a radio transmitter and six keys that measured 5.5 x 4 centimeters, or about 2 inches x 1.6 inches, each (see Figure 1). Five of the keys corresponded to destinations that Gloria had chosen for the session. Each key was covered with a small (discriminated) object that signaled the activity that was available at the related destination and was encircled with light-emitting diodes. As soon as Gloria pressed a key, the sound source at the corresponding destination started emitting a cue every 15 seconds (an interval that was deemed suitable for her), and the light-emitting diodes encircling the key switched off. The sound source was to be turned off by Gloria through the sixth key of the device as she reached (or neared) the destination.

Experimental conditions

The number of trips to destinations Gloria made correctly (independent of external guidance) were recorded. Interrater agreement was assessed on more than 20% of the sessions, and it exceeded 95%. The effects of the orientation system were assessed through an ABAB design in which A represented the baseline phases and B represented the intervention phases with the orientation system (Barlow, Nock, & Hersen, 2009). The first baseline phase was conducted in both the intervention and generalization settings. At the end of the second B phase, the orientation system was used in the generalization setting to assess generalization effects (Kazdin, 2001). Baseline and intervention conditions were typically used over two daily sessions (separated by intervals of 15 to 45 minutes), with five trips per session. The sessions began with Gloria at the start area of the settings (see Figure 1). A research assistant presented Gloria with a list of seven or eight activities by saying the verbal labels of the activities and handing Gloria small objects that signaled them. Gloria chose the five activities that she wanted to carry out. She had the objects signaling them on her lap during the baseline sessions, and these were attached to the keys of the control device during the intervention sessions. The five activities of the sessions were carried out in succession, all on Gloria's initiative or with some suggestions (such as about their sequence) by the research assistant. After completing a session, Gloria spent a little time talking with a research assistant about preferred topics like hairstyles and music.

Baseline. During the baseline phases, the orientation system was not in use, but the lights on the doors were available. Prior to each trip, Gloria was to select the object signaling the activity in which she was going to engage. A research assistant intervened with verbal or physical guidance if Gloria did not make any progress in the trip for more than one minute or failed to reach the destination within four to five minutes.

Intervention. The intervention phases differed from the baseline phases in that the orientation system was available. For each trip, Gloria was to select a key and a related object on the control device for which the encircling lights were on (see Orientation system). This selection produced the effects described earlier. The intervention was introduced by 5 practice sessions (of 15 minutes each) focusing on the appropriate use of the control device's keys and orientation to the sound sources' cues.

Generalization. Generalization sessions were carried out in the resource area (the generalization setting). Baseline conditions applied for the first two of these sessions (conducted at the start of the study), whereas intervention conditions applied for the last eight sessions (carried out at the end of the second intervention phase).

RESULTS

Gloria's mean percentage of correct trips was 5 during the first four baseline sessions and 10 during the two parallel generalization sessions (see Figure 2). Gloria's mean percentage of correct trips during the initial intervention phase was about 75. The mean percentage dropped to 20 during the second baseline phase and increased to about 90 during the second intervention phase (see Figure 2). A high percentage of correct trips were also made during the final generalization sessions (when the orientation system was used in the generalization setting).

DISCUSSION

These data extend previous evidence on the effectiveness of orientation technology and the possibility of generalizing its use across settings (Baldwin, 2003; Lancioni et al., 2007; Petry, Maes, & Vlaskamp, 2005). Helping wheelchair users with visual and intellectual disabilities is particularly important because these persons may have limited contact with the environment and minimal opportunities to learn directions or effective self-correction. Precautionary measures should be adopted, however, to reduce the risk that their wheelchair travel could be dangerous for other persons with visual disabilities who share their environment (Lancioni et al., 2007).

A system involving a reduced number of orientation sources and relatively infrequent cues, such as the one used in this study, appears to be more easily applicable across settings (and only marginally disturbing for other persons in the settings) as well as more economical. Obviously, the level of orientation guidance it provides is less detailed and thus less supportive than it would be in situations in which a larger number of sources and more frequent cues are available (Guth & LaDuke, 1994, 1995; Lancioni, O'Reilly, Oliva, & Bracalente, 1998; Lancioni et al., 2007). The lights at the doors may have facilitated Gloria's travel by minimizing wheelchair collisions or maneuvers and the time it took to reach a destination. Yet, they were not critical to the outcome, as was indicated by Gloria's baseline performance, which was poor irrespective of their presence during these phases.

The availability of a practical control device is a basic requirement for promoting independent travel across settings (see, for example, Baldwin, 2003; Martinsen et al., 2007). Large keys with small objects identifying the destinations or activities and light-emitting diodes that stay on until the keys are used may be critical features for such a device. Future research will need to replicate and extend the present study with new participants to verify the generality of the findings and possible improvements in the use and role of the technology.

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Giulio E. Lancioni, Ph.D., professor, Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy; e-mail: <[e-mail]>. Mark F. O'Reilly, Ph.D., Mollie Villeret Davis Professor of learning disabilities and professor of special education, Department of Special Education, University of Texas at Austin, 1 University Station, D 5300, Austin, TX 78712; e-mail: <[e-mail]>. Nirbhay N. Singh, Ph.D., senior scientist, ONE Research Institute, P.O. Box 5419, Midlothian, VA 23112; e-mail: <nirbsingh52@aol. com>. Jeff Sigafoos, Ph.D., professor, School of Educational Psychology and Pedagogy, Victoria University of Wellington, Box 17-310, Karori, Wellington, 6147, New Zealand; e-mail: <[e-mail]>. Francesca Campodonico, B.A., research assistant, Lega F. D'Oro Research Center, Via Montecerno 1, 60027 Osimo, Italy; e-mail: <[e-mail]>. Doretta Oliva, M.A., research coordinator, Lega F. D'Oro Research Center, Via Montecerno 1, 60027 Osimo, Italy; e-mail: <oliva.d@legadelfilodoro, it>.