Biomedical subjects

Nirbhay N Singh

Publications and source records attributed to Nirbhay N Singh.

At least 19 recordsLinked to original sources

PubMed2006

Enabling two persons with multiple disabilities to access environmental stimuli and ask for social contact through microswitches and a VOCA.

This study assessed the combination of two microswitches with a voice output communication aid (VOCA) with two persons (an adolescent and a young adult) with multiple disabilities. The microswitches allowed the participants to obtain direct access to preferred environmental stimuli; the VOCA enabled them to ask for caregiver's attention. Initially, the participants were taught to use each of the two microswitches individually and then together. Next, they were taught to use the VOCA and, eventually, this was available together with the microswitches. Results showed that the participants learned to operate the microswitches and the VOCA and used all three of them consistently when they were simultaneously available. Implications of these findings and the potential role of a VOCA combined with conventional microswitches were discussed.

Adolescent↗

PubMed2006

PECS and VOCAs to enable students with developmental disabilities to make requests: an overview of the literature.

This paper provides an overview of the literature dealing with the use of the Picture Exchange Communication System (PECS) and voice output communication aids (VOCAs) for promoting the performance of requests by students with developmental disabilities. Computerized and manual searches were carried out to identify the studies published during the last 15 years (i.e., the period between 1992 and 2006 during which PECS and VOCA approaches became popular). Thirty-seven studies were identified and then divided into three groups concerning the use of the PECS or equivalents, the use of VOCAs or equivalents, and the comparison of both these approaches, respectively. Of the 173 students involved in studies using the PECS or equivalents only three could be considered failures, while a fourth one did not progress in the program due to illness. Similarly, of the 39 students who used VOCAs or equivalents only three could be considered failures, while one was partly successful. Finally, of the 11 students involved in the comparisons between PECS and VOCAs none could be classified as a failure. The results are very encouraging but methodological concerns and the relatively limited use of the systems in terms of request items and request opportunities suggest caution. Caution may also be needed in interpreting the reported similarities between the two systems in usability and effectiveness.

Adolescent↗

PubMed2006

Fostering adaptive responses and head control in students with multiple disabilities through a microswitch-based program: follow-up assessment and program revision.

A program was recently developed to promote adaptive responses and upright head position in students with multiple disabilities through the use of microswitch clusters (i.e., combinations of two microswitches). The five students exposed to the program showed a significant increase in adaptive responses performed with head upright. The first purpose of this study was to carry out a long-term follow-up assessment of the five students' frequencies of adaptive responses and percentages of those responses combined with head upright. Recordings were also made of the length of time the head position was kept during each stimulation period following a successful response event and through the sessions. The second purpose of this study was to arrange a program revision for the students with less favorable data on head upright. The revision consisted of making the stimulation following successful response events synchronous with head upright with a maximum duration of 9s per event. The results of the follow-up assessment showed that two of the students kept the upright head position for nearly the entire stimulation periods that followed successful response events as well as much of the session time. The other three students kept such position for small or intermediate portions of the stimulation periods and of the session time. For these three students, the revised program was applied with substantial benefits. Implications of the findings were discussed.

Abnormalities, Multiple↗

PubMed2006

Enabling students with multiple disabilities to request and choose among environmental stimuli through microswitch and computer technology.

This study assessed the possibility of enabling two students with multiple disabilities to request and choose among environmental stimuli through microswitch and computer technology. Each student was provided with two basic microswitches the activation of which made a computer system present a sample of a preferred or non-preferred stimulus. The student could select or reject such a stimulus by vocal utterances discriminated by the computer system as 'yes' or 'no'. If the student selected the stimulus, the computer system presented it for a preset time. If the student rejected the stimulus, the computer system waited for the next input of one of the basic microswitches. Data showed that both students learned to activate the basic microswitches consistently, selected the preferred stimuli about 90% of the times, and largely rejected the non-preferred stimuli. The students also showed some preferences between the two basic microswitches/responses. The performance was maintained at the post-intervention checks carried out 3 and 6 weeks after the end of the intervention. Implications of the findings are discussed technically, practically, and in terms of quality of life.

Adolescent↗

PubMed2006

Enhancing treatment team process through mindfulness-based mentoring in an inpatient psychiatric hospital.

The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then introduced mindfulness-based mentoring successively across the treatment teams. Following intervention, four follow-up assessments at 3-month intervals were undertaken to assess the durability of the enhanced treatment team functioning levels in the absence of mentoring. Results showed that with the introduction of mindfulness-based mentoring, treatment team performance was enhanced, patients'attendance at therapeutic groups and individual therapy sessions was maximized, and patient and staff satisfaction with treatment team functioning was substantially increased, with patient satisfaction showing greater gains than staff satisfaction. Mindfulness-based mentoring may be an efficient and effective intervention for enhancing and maintaining the performance of treatment teams in adult psychiatric hospitals.

Adult↗

PubMed2006

Microswitch clusters promote adaptive responses and reduce finger mouthing in a boy with multiple disabilities.

The authors assessed new microswitch clusters (i.e., combinations of two microswitches) and contingent stimulation to increase adaptive responses (i.e., foot and head movements) and reduce aberrant behavior (i.e., finger mouthing)in a boy with multiple disabilities. Initially, intervention was directed at increasing the frequency of each adaptive response, individually, through contingent use of preferred stimuli. Subsequently, adaptive responses led to preferred stimuli only if they occurred in the absence of finger mouthing. Postintervention checks occurred 1, 2, and 3 months after the end of the intervention. Data showed that the boy (a) increased the frequency of the adaptive responses extensively, (b) learned to perform these responses largely free from finger mouthing, and (c) maintained these changes over time. The importance of microswitch clusters to simultaneously pursue the dual objective of promoting adaptive responses and reducing aberrant ones is underlined.

Abnormalities, Multiple↗

PubMed2006

Questions about behavioral function in mental illness (QABF-MI): a behavior checklist for functional assessment of maladaptive behavior exhibited by individuals with mental illness.

The Questions About Behavioral Function (QABF), a 25-item rating scale, was developed to identify the function(s) of maladaptive behavior in individuals with developmental disabilities. The authors adapted it for use with individuals with serious mental illness who engage in maladaptive behavior and assessed the psychometric characteristics of the new scale (Questions About Behavioral Function in Mental Illness; QABF-MI) in a sample of 135 adults with serious mental illness from three inpatient psychiatric hospitals. Staff most familiar with each person rated each item on a 5-point Likert-type rating scale, and the ratings were subjected to a number of psychometric analyses. The results of factor analyses provided a conceptually meaningful five-factor solution: physical discomfort, social attention, tangible reinforcement, escape, and nonsocial reinforcement. Congruence between the five factors derived with the QABF-MI and the corresponding factors in the original QABF was perfect. The results indicated that the QABF-MI has robust psychometric properties and may be useful as a screening tool for determining the nature of the variables that maintain maladaptive behavior exhibited by individuals with serious mental illness.

Adaptation, Psychological↗

PubMed2006

Teaching 'Yes' and 'No' responses to children with multiple disabilities through a program including microswitches linked to a vocal output device.

The present study introduced two children (a boy and a girl of 9.2 and 12.3 yr. of age, respectively, with multiple disabilities) to an intervention program for establishing Yes and No responses in relation to preferred and nonpreferred stimuli and assessed the acquisition and generalization of those responses. The program involved the use of microswitches, which monitored the nonverbal Yes and No responses performed by the children and ensured that these responses produced the matching verbal utterances via a vocal output device. Analysis showed children acquired Yes and No responses in relation to the stimuli used for the intervention and, to a comparable degree, to the stimuli used for generalization checks as well. An interview of 30 educational staff of a center for persons with multiple disabilities indicated that they considered the presence of Yes and No verbal utterances preferable to the absence of such utterances, and thought that the utterances could be helpful for the children's response acquisition and would be useful and pleasing for staff and parents. General implications of the findings were discussed.

Child↗

PubMed2005

Mindful staff increase learning and reduce aggression in adults with developmental disabilities.

Aggression by individuals with developmental disabilities may threaten their community placement. In a multiple baseline design across group homes, we provided group home staff with behavioral training and later with mindfulness training to assess the impact on aggressive behaviors and the number of learning objectives mastered by individuals in their care. We also assessed other outcomes including activities engaged in by the individuals, use of restraint by staff, and measures of satisfaction. The effect of varying staff-resident ratios was evaluated on all measures. When compared to baseline, the number of staff interventions for aggression showed some reduction following behavioral training, but decreased substantially only following mindfulness training. There was also some increase in the number of learning objectives mastered by the individuals following behavioral training, but greater and more consistent increases were obtained only after mindfulness training. Improvements also occurred on the other measures assessed after behavioral training, but these were always greater and more consistent following mindfulness training. In addition, consistent gains followed behavioral training only with a high staff-resident ratio whereas the larger gains after mindfulness training occurred with both medium and low staff-resident ratios. Our results suggest that the addition of mindfulness training considerably enhanced the ability of the group home staff to effectively manage the aggressive behavior and learning of the individuals.

Adult↗

PubMed2005

Guidelines for the use of clozapine in individuals with developmental disabilities.

Clozapine is the most effective antipsychotic medication currently in use, but there has been a paucity of well-controlled research on its efficacy with people with developmental disabilities. We present a set of guidelines to ensure proper utilization of clozapine in individuals with developmental disabilities, because it can offer them therapeutic advantages similar to those observed in people with schizophrenia. We provide recommendations regarding the use of clozapine that are based on three main sources: literature and published professional practice guidelines regarding the use of clozapine in individuals who do not have developmental disabilities, the limited literature on the use of clozapine in individuals who have developmental disabilities, and our own clinical experience. The first part of the guidelines contains an overview of necessary practical knowledge regarding side effects, dose and blood level considerations, and interactions with other medications, diet and tobacco smoking. In the second part, we offer procedures for selecting individuals for clozapine therapy based on proper indications and contraindications for treatment. We also include requirements regarding informed consent, dosage and special laboratory and clinical monitoring.

Adult↗

PubMed2005

Children with multiple disabilities and minimal motor behavior using chin movements to operate microswitches to obtain environmental stimulation.

In these two studies, two children with multiple disabilities and minimal motor behavior were assessed to see if they could use chin movements to operate microswitches to obtain environmental stimulation. In Study I, we applied an adapted version of a recently introduced electronic microswitch [Lancioni, G. E., O'Reilly, M. F., Singh, N. N., Sigafoos, J., Oliva, D., & Baccani, S., et al. (2004). Technological aids to promote basic developmental achievements by children with multiple disabilities: evaluating two cases. Cognitive Processing 5, 232-238]. In Study II, we set up a new microswitch detecting the chin-movement response through an optic sensor. Each study was carried out according to an ABAB sequence in which A represented baseline and B intervention phases. A 2-month post-intervention check also occurred. The data showed that both children increased the frequency of the chin response, thus increasing the level of environmental stimulation, during the intervention phases. This performance was retained at the post-intervention check. The overall suitability of this response and related microswitches as well as the need to explore other potential responses and microswitches for children with minimal motor behavior is discussed.

Brain Diseases↗

PubMed2004

A microswitch program to foster simple foot and leg movements in adult wheelchair users with multiple disabilities.

This study assessed a microswitch program to foster simple foot and leg movements in 2 adult wheelchair users with multiple disabilities. The participants' mood (indices of happiness) was recorded throughout the study. Data showed that participants rapidly increased the target foot and leg movements and maintained those movements during the course of the study, which lasted about 4.5 months. With regard to indices of happiness, 1 participant showed a fairly modest increase during the intervention while the other participant showed a substantial increase. Implications of the findings are discussed.

Abnormalities, Multiple↗

PubMed2004

A microswitch program including words and choice opportunities for students with multiple disabilities.

Two students with multiple disabilities were provided with two or three request microswitches and one choice microswitch. Activation of a request microswitch triggered the verbal announcement of one of the stimulus events related to it. The student could choose such an event through the choice microswitch or bypass it. The request microswitches were introduced individually and made available simultaneously by the end of the intervention and the postintervention period. Analysis showed that both students learned to use the microswitches. Transfer of the microswitch program into the students' home was very successful with one student and presented some difficulties with the other. Implications of the findings and new possible developments were discussed.

Adolescent↗

PubMed2002

Therapeutic potential of kava in the treatment of anxiety disorders.

Anxiety disorders are among the most common psychiatric disorders that affect all age groups of the general population. Currently, the preferred treatment is with pharmacological drugs that have antidepressant or anti-anxiety properties. However, these agents have numerous and often serious adverse effects, including sedation, impaired cognition, ataxia, aggression, sexual dysfunction, tolerance and dependence. Withdrawal reactions on termination after long-term administration are also a major limiting factor in the use of these agents. Herbal remedies, including kava (Piper methysticum), have been shown to be effective as alternative treatments, at least in mild to moderate cases of anxiety. Kava is a social and ceremonial herb from the South Pacific. It is available in the west as an over-the-counter preparation. Its biological effects, due to a mixture of compounds called kavalactones, are reported to include sedative, anxiolytic, antistress, analgesic, local anaesthetic, anticonvulsant and neuroprotective properties. The pharmacological properties of kava are postulated to include blockade of voltage-gated sodium ion channels, enhanced ligand binding to gamma-aminobutyric acid (GABA) type A receptors, diminished excitatory neurotransmitter release due to calcium ion channel blockade, reduced neuronal reuptake of noradrenaline (norepinephrine), reversible inhibition of monoamine oxidase B and suppression of the synthesis of the eicosanoid thromboxane A(2), which antagonises GABA(A) receptor function. Clinical studies have shown that kava and kavalactones are effective in the treatment of anxiety at subclinical and clinical levels, anxiety associated with menopause and anxiety due to various medical conditions. Until recently, the adverse effects attributed to kava use were considered mild or negligible, except for the occurrence of a skin lesion. This disorder, called kava dermopathy, occurs only with prolonged use of large amounts of kava and is reversible on reduced intake or cessation. Rare cases of interactions have occurred with pharmaceutical drugs that share one or more mechanisms of action with the kavalactones. In the past few years, about 35 cases of severe liver toxicity associated with kava intake have been reported in Europe and the US. However, a direct causal relationship with kava use has been difficult to establish in the majority of the cases, and there is insufficient evidence to implicate kava as the responsible agent. Nevertheless, until further research clarifies any causality, kava should be used with caution.

Animals↗

PubMedDate not supplied

Assessing the effects of automatically delivered stimulation on the use of simple exercise tools by students with multiple disabilities.

We assessed the effects of automatically delivered stimulation on the activity level and mood (indices of happiness) of three students with multiple disabilities during their use of a stepper and a stationary bicycle. The stimulation involved a pool of favorite stimulus events that were delivered automatically, through an electronic control system, while the students were active in using the aforementioned exercise tools. Data showed that stimulation had an overall positive impact, but this was not evident on both measures (i.e., level of activity and indices of happiness) or with both exercise tools across students. These findings are discussed in relation to the outcome of an earlier study in the area by the same authors and in terms of practical implications for daily contexts.

Adult↗

PubMedDate not supplied

Mindful caregiving increases happiness among individuals with profound multiple disabilities.

Happiness is a critical indicator of quality of life in humans. A few studies have measured levels of happiness displayed under different conditions by individuals with profound multiple disabilities. We were interested in determining whether increasing the mindfulness of caregivers would result in increased levels of happiness in adults with these conditions. Using alternating treatments embedded within a multiple baseline across caregivers design, we measured baseline levels of happiness displayed by three adults with profound multiple disabilities when they engaged in leisure activities, each by a different pair of caregivers. Then, we taught mindfulness methods to one of each pair and measured the levels of happiness displayed by the individuals during the 8-weeks training for the caregivers. Finally, we measured the levels of happiness displayed by the three individuals for 16 weeks following the termination of mindfulness training. We found that, regardless of whether the level of happiness was initially observed to be high or low in the presence of a caregiver, it increased markedly when an individual interacted with a caregiver who received training in mindfulness when compared to the control caregiver, who did not receive such training. Our study provides evidence that increasing the mindfulness of a caregiver can produce a substantial increase in the levels of happiness displayed by individuals with profound multiple disabilities.

Abnormalities, Multiple↗

PubMedDate not supplied

Using computer systems as microswitches for vocal utterances of persons with multiple disabilities.

We assessed the effects of two computer systems used as microswitches for the vocal utterances of an adolescent and a young adult with multiple disabilities. The systems were to respond to three one-syllable utterances of the first participant and nine word-like utterances of the second participant by presenting favorite stimuli linked to those utterances. The computer system used for the first participant relied on a software program developed specifically for this study. The computer system used for the second participant combined a new software program with a commercially available speech recognition program. Results showed that both participants increased the frequencies of their target utterances and obtained high levels of stimulation. Positive performance was maintained at post-intervention checks. Technical and practical implications of the data are discussed.

Abnormalities, Multiple↗

PubMedDate not supplied

Effects of Snoezelen room, Activities of Daily Living skills training, and Vocational skills training on aggression and self-injury by adults with mental retardation and mental illness.

Multi-sensory stimulation provided in a Snoezelen room is being used increasingly for individuals with mental retardation and mental illness to facilitate relaxation, provide enjoyment, and inhibit behavioral challenges. We observed aggressive and self-injurious behavior in three groups of 15 individuals with severe or profound mental retardation and mental illness before, during, and after being in a Snoezelen room. All participants were receiving psychotropic medication for their mental illness and function-derived behavioral interventions for aggression, self-injury, or both. Using a repeated measures counterbalanced design, each group of participants was rotated through three experimental conditions: Activities of Daily Living (ADL) skills training, Snoezelen, and Vocational skills training. All other treatment and training activities specified in each individual's person-centered plan were continued during the 10-week observational period. Both aggression and self-injury were lowest when the individuals were in a Snoezelen room, followed by Vocational skills training and ADL skills training. The levels in the Snoezelen room were significantly lower than in both the other conditions for aggression but only in ADL skills training for self-injury. The difference in levels before and after Snoezelen were statistically significant with self-injury but not with aggression. The order of conditions showed no significant effect on either behavior. Snoezelen may provide an effective context for reducing the occurrence of self-injury and aggression.

Activities of Daily Living↗