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Contents lists available at ScienceDirect
Research in Developmental Disabilities
Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard Man-Ling Chang a, Ching-Hsiang Shih b,* a b
Department of Special Education, National Taiwan Normal University, Taipei, Taiwan, ROC Department of Special Education, National Dong Hwa University, Hualien, Taiwan, ROC
A R T I C L E I N F O
A B S T R A C T
Article history: Received 7 April 2014 Accepted 8 April 2014 Available online xxx
The principle of this study was to use the finger-pressing position detection program (FPPDP) with a standard keyboard to improve the fine motor activities of disabled people through environmental stimulation. The FPPDP is a software solution which turns a standard keyboard into a finger-pressing position detector. By using this technique, this study tried to find out whether two students with developmental disabilities would be able to effectively perform fine motor activities through the triggering of environmental stimulation. This study was based on an ABAB design and the results showed that both participants demonstrated an obvious increase in terms of their willingness to perform target responses during the intervention phases. The practical and developmental implications of the findings are discussed. ß 2014 Elsevier Ltd. All rights reserved.
Keywords: FPPDP Keyboard Fine motor activities
1. Introduction Recent studies showed that disabled people could improve their level of response, environmental stimulation control, and self-determination through controlling their favorite environmental stimulation by using simple behavioral actions with suitable detectors and assistive programs (Lancioni, O’Reilly, Singh, Oliva, Coppa, et al., 2005; Lancioni, Singh, O’Reilly, & Sigafoos, 2009; Shih & Chang, 2012a, 2012b; Shih, Chang, & Mohua, 2012; Shih, Wang, Chang, & Kung, 2012). Here, stimulations included playing a favorite video or song, activating toys or other sources of stimulation that constituted interesting incentives for disabled people. Target responses were simple and specific behaviors which researchers expected disabled people could achieve, such as thumb/finger poking/pressing, head-turning, standing posture changing, limb moving, hand pushing/swinging, etc. To enable disabled people to control environmental stimulation through simple behavioral actions, three points need to be considered: (a) identifying and selecting a plausible target response (Lancioni, Singh, O’Reilly, & Sigafoos, 2009; Lancioni, Singh, O’Reilly, Sigafoos, Didden, et al., 2009), (b) designing or selecting suitable detectors, sensors or switches to detect these
* Corresponding author at: Department of Special Education, National Dong Hwa University, Hualien 970, Taiwan, ROC. Tel.: +886 3 8634881; fax: +886 3 8634870. E-mail address: [email protected] (C.-H. Shih). http://dx.doi.org/10.1016/j.ridd.2014.04.011 0891-4222/ß 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
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responses (Lancioni, O’Reilly, Singh, Oliva, Coppa, et al., 2005; Lancioni, O’Reilly, Singh, Oliva, Scalini, et al., 2005), and (c) developing matched assistive programs to control environmental stimulation based on the response (Shih & Chang, 2012a; Shih, Chung, Shih, & Chen, 2011; Shih, Shih, & Shih, 2011). In recent studies, software technology was adopted for modifying and resetting the default functions of various commercial high-tech products which contained a number of special sensors to detect specific behaviors. This software technology turned these products into high performance assistive devices which were then used as useful tools for many applications suitable for people with disabilities, and achieved encouraging results (Shih, 2011a; Shih & Chang, 2012a; Shih, Chang, et al., 2012; Shih, Chen, & Shih, 2012; Shih & Shih, 2010a, 2010b; Shih, Yeh, Shih, & Chang, 2011). For example, a mouse was modified to make it a precise two-dimensional hand motion detector (Shih & Shih, 2009) and used as a thumb/ finger poke detector (Shih, Shih, Lin, & Chiang, 2009). A trackball was modified to become a precise thumb/finger poke detector (Shih & Shih, 2010b). A Nintendo Wii Balance Board was used as a high performance change of standing posture (CSP) detector (Shih, Shih, & Chiang, 2010) and a wireless object location detector (Shih & Chang, 2012b). A Nintendo Wii Remote Controller with a three-axis accelerometer sensor was applied as a precise limb action detector (Shih, Chang, & Shih, 2010), head position/angle detector (Shih, Shih, et al., 2011), and three-dimensional object orientation detector (Shih, Chang, et al., 2012). A gyration air mouse with gyroscope sensor was used to serve as a precise limb action detector (Shih, Chang, & Shih, 2010), and a battery-free wireless mouse (Radio Frequency Identification – RFID sensor) was modified to make it an object location detector (Shih, 2011b). The keyboard is one of the basic input devices for computers. It is a typewriter-style device with an arrangement of keys, and each press of a key corresponds to a character, number, sign or command (Wikipedia, 2014). Based on these characteristics, the keyboard can be regarded as a device embedded with multiple switch sensors, and can detect the status of the individual key which was pressed or released. From a special education or rehabilitation perspective, a keyboard device can be used as a special finger-pressing position detector that can detect the fine pressing behavior of fingers, but the premise is that certain technical ability is required to modify the default functions of a keyboard device. Since a keyboard is a standard device for a computer, its driver is already built into the computer operating system (OS). Once the keyboard is connected to the computer, the OS will identify it as a keyboard device and will install its driver automatically. Hence, to change the functionality of keyboard devices for use in special education or rehabilitation, the assistance of new driver software is necessary. Shih (2012) used software technology to develop a finger-pressing position detection program (FPPDP) to modify the keyboard driver in order to reset a keyboard’s default functions. FPPDP is able to intercept keyboard actions and turn a standard keyboard into a high performance finger-pressing position detector. In this previous study, two participants had to use their fingers to point correctly at one of the two pre-defined keys, and then point at the other one after about 6 s to trigger their preferred stimulation. The experiment results were positive and participants’ correct target responses were significantly increased during the intervention phase. This study extended the research into FPPDP application (Shih, 2012) and was conducted on two students with developmental disabilities and fine motor difficulties in order to evaluate whether they could actively perform fine motor activities by controlling their favorite stimulation using a wireless keyboard. More complex fine motor skills were required in this experiment, in the sense that participants needed to correctly press three pre-defined keys with their three fingers simultaneously on the keyboard. After the stimulation was triggered for 6 s, they needed to move their fingers to point to three other pre-defined positions on the keyboard at the same time. 2. Methodology 2.1. Participants The participants, Liu and Wang, were 18 and 16 years of age, respectively. Both were rated as possessing moderate intelligence, with profound multiple disabilities including difficulties with communication due to cerebral palsy, poor fine finger motor skills, and slowness of movement. Liu had no vocal ability, and could only express himself by nodding and shaking his head. Wang spoke little, but liked interacting with people. Their vision and hearing were normal with good auditory comprehension and both participants understood all statements. They both had experience using computers, and liked watching movies/videos, which meant that these could be used as participants’ preferred environmental stimulation. Both personalities were gentle and both participants had a willingness to learn. After receiving guidance from the research assistant, both participants could understand that they needed to move their fingers to point to correct positions in order to trigger the interesting stimulation. Both participants’ parents were informed of and agreed to allow their children to participate in this study. 2.2. Target response, keyboard setting, and control system The configuration of this study included: (a) a control system (a minicomputer) with FPPDP software installed, (b) a largesize TV was used to play participants’ favorite videos (environmental stimulation), as shown in Fig. 1, (c) six pre-defined positions were set up on the ‘‘E’’, ‘‘S’’, ‘‘X’’, ‘‘-’’, ‘‘P’’, and ‘‘[’’ keys of a wireless keyboard, and were marked as P1, P2, P3, P4, P5, P6 with red-colored stickers, as shown in Fig. 2.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
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Fig. 1. A control system (Eee Box minicomputer) with FPPDP software installed was connected to a TV to play participants’ preferred environment stimulation.
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Fig. 2. Six pre-defined positions P1, P2, P3, P4, P5 and P6 were marked with red stickers so participants could quickly identify the positions on the keyboard.
In this study, the target response was a sequence of participants’ fine motor activities. First, participants had to precisely point to three pre-defined positions – P1, P2, and P3 with their three fingers at the same time. If a valid response was detected, participants would be rewarded with their favorite environmental stimulation. The stimulation would be continued for 6 s and then stopped. Next, participants had to move their fingers to the other three pre-defined positions – P4, P5 and P6, pressing the three keys simultaneously to perform a new valid target response in order to trigger a new 6 s stimulation. This action was repeated until the end of the experiment. The stimulation consisted of the participants’ favorite videos, provided by their parents. In order to detect the target responses, a standard wireless keyboard was used to detect keyboard keystroke status and transmit this data via wireless to the control system. In this study, an ASUS Eee Box minicomputer (ASUS, 2013) was used as a control system. The Eee Box minicomputer was a standard Windows Operating System (OS) computer with FPPDP software installed in order to disable the standard keyboard functions and distinguish which key had been pressed or released. 2.3. Experimental conditions This study used an ABAB design, where A represented the baseline and B represented intervention phases (Richards et al., 1999). Both participants underwent three to five 3-min experimental sessions per day at their school, and experimental data were automatically recorded by the control system. 2.3.1. Baseline phases The participants underwent 18 and 12 sessions, respectively, during the baseline phase. All the devices were available, but no simulation would be triggered, even though participants performed a correct response during this phase. Both participants would receive vocal promptings from a research assistant to perform responses if they did not perform a valid response within 1 min. 2.3.2. Intervention phases The participants underwent 48 and 42 sessions, respectively, during the intervention phase. The setting was the same as in the baseline phase, but the stimulation would be triggered during this phase whenever participants performed a correct response.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
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Fig. 3. Liu’s data. Each data point on the graph represents an average of three experimental sessions.
Fig. 4. Wang’s data. Each data point on the graph represents an average of three experimental sessions.
2.4. Results Experimental data of participant Liu are shown in Fig. 3. In the first baseline phase, Liu had an average of about 3.67 correct responses per session. In the first intervention phase, the average number of responses increased to 19.75 responses per session. The average dropped to 2.75 during the second baseline phase and then increased again to 20.29 in the second intervention phase. The differences in correct response frequencies between the baseline and the intervention phases were significant (p < 0.01) based on the Kolmogorov–Smirnov test (Siegel & Castellan, 1988). Experimental data of participant Wang is shown in Fig. 4. Wang had an average of 2.83 valid responses per session in Baseline I, while the number of correct target responses increased to 15.94 per session in Intervention I. The average value dropped to 3.50 during Baseline II and then increased to 17.79 for Intervention II. The differences between the baseline responding frequencies and the intervention responding frequencies were also significant (p < 0.01) based on the Kolmogorov–Smirnov test (Siegel & Castellan, 1988). According to the experimental results from Figs. 3 and 4, both participants did not have much willingness to carry out the assigned fine motor activities during the baseline phases, and the number of correct responses per session was low during this phase. But during the intervention phases, due to the intervention of preferred environmental stimulation, participants showed a high willingness to perform fine motor activities and the number of valid responses per session increased rapidly. 3. Discussion The keyboard is a precision device, designed to be used as an input device for a computer, and can precisely detect the status of each key pressed or released. With the assistance of software technology, the applications of a standard keyboard can be altered (Shih, 2012). In this study, we adopted the previously developed FPPDP software to extend the default functions of a keyboard device, turning it into a high performance assistive device (i.e. a finger-pressing position detector) for detecting fine motor activities. The experiment was designed so that participants needed to press three keys with their three fingers at the same time on the keyboard and needed to move their hands from one side of the keyboard to the other side. Those motions can improve their finger control ability, increase their body coordination, and enhance their confidence and self-esteem. According to the experimental results, both participants increased their willingness to control the stimulation through performing assigned fine motor activities, and had significantly increased the number of correct target responses which triggered their favorite stimulation during the intervention phase.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
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All devices used in this study were standard devices and could be easily obtained. There are many advantages of using standard devices, such as low cost, ready availability, good technical support, the fact that various models can be chosen, etc. Besides the keyboard, there are many other precision devices that can also be used as assistive technology devices. The application of software technology can be a way to apply these devices in the fields related to helping people with disabilities and other special needs. The results show that subjects exhibited great improvement in terms of fine motor activities, but this study only focused on two students with developmental disabilities who could perform fine motor activities by using a standard keyboard through environmental stimulation, and people with different types of disabilities were not addressed here. In further studies, more applications need to be considered for other people with multiple disabilities. In addition, future experiments can be carried out by arranging more complex fine motor activities and using more than one keyboard. Hopefully, the implementation of a standard keyboard can provide disabled people with more options when it comes to assistive technology and make such assistance affordable in educational and home contexts. Acknowledgements The authors would like to thank the National Science Council, Taiwan, ROC for financially supporting this research under Contract No. NSC 102-2511-S-259-012. References ASUS. (2013). Eee Box mini computer Retrieved from http://www.asus.com/Eee_Box_PCs/EeeBox_PC_EB1021/.. Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Oliva, D., Coppa, M. M., & Montironi, G. (2005). A new microswitch to enable a boy with minimal motor behavior to control environmental stimulation with eye blinks. Behavioral Interventions, 20, 147–153. Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Oliva, D., Scalini, L., Vigo, C. M., et al. (2005). Micro-switch clusters to enhance hand responses and appropriate head position in two children with multiple disabilities. Developmental Neurorehabilitation, 8, 59–62. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., & Sigafoos, J. (2009). An overview of behavioral strategies for reducing hand-related stereotypies of persons with severe to profound intellectual and multiple disabilities: 1995–2007. Research in Developmental Disabilities, 30, 20–43. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Didden, R., & Oliva, D. (2009). Two boys with multiple disabilities increasing adaptive responding and curbing dystonic/spastic behavior via a microswitch-based program. Research in Developmental Disabilities, 30, 378–385. Shih, C.-H. (2011a). Assisting people with Attention Deficit Hyperactivity Disorder by actively reducing limb hyperactive behavior with a gyration air mouse through a controlled environmental stimulation. Research in Developmental Disabilities, 32, 30–36. Shih, C.-H. (2011b). An object location detector enabling people with developmental disabilities to control environmental stimulation through simple occupational activities with battery-free wireless mice. Research in Developmental Disabilities, 32, 818–823. Shih, C.-H. (2012). A finger-pressing position detector for assisting people with developmental disabilities to control their environmental stimulation through fine motor activities with a standard keyboard. Research in Developmental Disabilities, 33, 1360–1365. Shih, C.-H., & Chang, M.-L. (2012a). Enabling people with developmental disabilities to actively follow simple instructions and perform designated occupational activities according to simple instructions with Battery-free wireless mice by controlling environmental stimulation. Research in Developmental Disabilities, 33, 2013–2019. Shih, C.-H., & Chang, M.-L. (2012b). A wireless object location detector enabling people with developmental disabilities to control environmental stimulation through simple occupational activities with Nintendo Wii Balance Boards. Research in Developmental Disabilities, 33, 983–989. Shih, C.-H., Chang, M.-L., & Mohua, Z. (2012). A three-dimensional object orientation detector assisting people with developmental disabilities to control their environmental stimulation through simple occupational activities with a Nintendo Wii Remote Controller. Research in Developmental Disabilities, 33, 484–489. Shih, C.-H., Chang, M.-L., & Shih, C.-T. (2010a). A limb action detector enabling people with multiple disabilities to control environmental stimulation through limb action with a Nintendo Wii Remote Controller. Research in Developmental Disabilities, 31, 1047–1053. Shih, C.-H., Chang, M.-L., & Shih, C.-T. (2010b). A new limb movement detector enabling people with multiple disabilities to control environmental stimulation through limb swing with a gyration air mouse. Research in Developmental Disabilities, 31, 875–880. Shih, C.-H., Chen, L.-C., & Shih, C.-T. (2012). Assisting people with disabilities to actively improve their collaborative physical activities with Nintendo Wii Balance Boards by controlling environmental stimulation. Research in Developmental Disabilities, 33, 39–44. Shih, C.-H., Chung, C.-C., Shih, C.-T., & Chen, L.-C. (2011). Enabling people with developmental disabilities to actively follow simple instructions and perform designated physical activities according to simple instructions with Nintendo Wii Balance Boards by controlling environmental stimulation. Research in Developmental Disabilities, 32, 2780–2784. Shih, C.-H., Shih, C.-J., & Shih, C.-T. (2011). Assisting people with multiple disabilities by actively keeping the head in an upright position with a Nintendo Wii Remote Controller through the control of an environmental stimulation. Research in Developmental Disabilities, 32, 2005–2010. Shih, C.-H., & Shih, C.-T. (2009). A new movement detector to enable people with multiple disabilities to control environmental stimulation with hand swing through a commercial mouse. Research in Developmental Disabilities, 30, 1196–1202. Shih, C.-H., & Shih, C.-T. (2010a). Assisting people with multiple disabilities improve their computer pointing efficiency with thumb poke through a standard trackball. Research in Developmental Disabilities, 31, 1615–1622. Shih, C.-H., & Shih, C.-T. (2010b). Assisting two children with multiple disabilities and minimal motor behavior to control environmental stimulation with thumb poke through a trackball. Behavioural and Cognitive Psychotherapy, 38, 211–219. Shih, C.-H., Shih, C.-T., & Chiang, M.-S. (2010). A new standing posture detector to enable people with multiple disabilities to control environmental stimulation by changing their standing posture through a commercial Wii Balance Board. Research in Developmental Disabilities, 31, 281–286. Shih, C.-H., Shih, C.-T., Lin, K.-T., & Chiang, M.-S. (2009). Assisting people with multiple disabilities and minimal motor behavior to control environmental stimulation through a mouse wheel. Research in Developmental Disabilities, 30, 1413–1419. Shih, C.-H., Wang, S.-H., Chang, M.-L., & Kung, S.-Y. (2012). Assisting patients with disabilities to actively perform occupational activities using battery-free wireless mice to control environmental stimulation. Research in Developmental Disabilities, 33, 2221–2227. Shih, C.-H., Yeh, J.-C., Shih, C.-T., & Chang, M.-L. (2011). Assisting children with Attention Deficit Hyperactivity Disorder actively reduce limb hyperactive behavior with a Nintendo Wii Remote Controller through controlling environmental stimulation. Research in Developmental Disabilities, 32, 1631–1637. Siegel, S., & Castellan, N. J. (1988). Nonparametric statistics for the behavioral sciences. New York: McGraw-HiU Book Company. Wikipedia. (2014). Computer keyboard Retrieved from http://en.wikipedia.org/wiki/Computer_keyboard.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
RIDD-2284; No. of Pages 5 Research in Developmental Disabilities xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Research in Developmental Disabilities
Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard Man-Ling Chang a, Ching-Hsiang Shih b,* a b
Department of Special Education, National Taiwan Normal University, Taipei, Taiwan, ROC Department of Special Education, National Dong Hwa University, Hualien, Taiwan, ROC
A R T I C L E I N F O
A B S T R A C T
Article history: Received 7 April 2014 Accepted 8 April 2014 Available online xxx
The principle of this study was to use the finger-pressing position detection program (FPPDP) with a standard keyboard to improve the fine motor activities of disabled people through environmental stimulation. The FPPDP is a software solution which turns a standard keyboard into a finger-pressing position detector. By using this technique, this study tried to find out whether two students with developmental disabilities would be able to effectively perform fine motor activities through the triggering of environmental stimulation. This study was based on an ABAB design and the results showed that both participants demonstrated an obvious increase in terms of their willingness to perform target responses during the intervention phases. The practical and developmental implications of the findings are discussed. ß 2014 Elsevier Ltd. All rights reserved.
Keywords: FPPDP Keyboard Fine motor activities
1. Introduction Recent studies showed that disabled people could improve their level of response, environmental stimulation control, and self-determination through controlling their favorite environmental stimulation by using simple behavioral actions with suitable detectors and assistive programs (Lancioni, O’Reilly, Singh, Oliva, Coppa, et al., 2005; Lancioni, Singh, O’Reilly, & Sigafoos, 2009; Shih & Chang, 2012a, 2012b; Shih, Chang, & Mohua, 2012; Shih, Wang, Chang, & Kung, 2012). Here, stimulations included playing a favorite video or song, activating toys or other sources of stimulation that constituted interesting incentives for disabled people. Target responses were simple and specific behaviors which researchers expected disabled people could achieve, such as thumb/finger poking/pressing, head-turning, standing posture changing, limb moving, hand pushing/swinging, etc. To enable disabled people to control environmental stimulation through simple behavioral actions, three points need to be considered: (a) identifying and selecting a plausible target response (Lancioni, Singh, O’Reilly, & Sigafoos, 2009; Lancioni, Singh, O’Reilly, Sigafoos, Didden, et al., 2009), (b) designing or selecting suitable detectors, sensors or switches to detect these
* Corresponding author at: Department of Special Education, National Dong Hwa University, Hualien 970, Taiwan, ROC. Tel.: +886 3 8634881; fax: +886 3 8634870. E-mail address: [email protected] (C.-H. Shih). http://dx.doi.org/10.1016/j.ridd.2014.04.011 0891-4222/ß 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
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responses (Lancioni, O’Reilly, Singh, Oliva, Coppa, et al., 2005; Lancioni, O’Reilly, Singh, Oliva, Scalini, et al., 2005), and (c) developing matched assistive programs to control environmental stimulation based on the response (Shih & Chang, 2012a; Shih, Chung, Shih, & Chen, 2011; Shih, Shih, & Shih, 2011). In recent studies, software technology was adopted for modifying and resetting the default functions of various commercial high-tech products which contained a number of special sensors to detect specific behaviors. This software technology turned these products into high performance assistive devices which were then used as useful tools for many applications suitable for people with disabilities, and achieved encouraging results (Shih, 2011a; Shih & Chang, 2012a; Shih, Chang, et al., 2012; Shih, Chen, & Shih, 2012; Shih & Shih, 2010a, 2010b; Shih, Yeh, Shih, & Chang, 2011). For example, a mouse was modified to make it a precise two-dimensional hand motion detector (Shih & Shih, 2009) and used as a thumb/ finger poke detector (Shih, Shih, Lin, & Chiang, 2009). A trackball was modified to become a precise thumb/finger poke detector (Shih & Shih, 2010b). A Nintendo Wii Balance Board was used as a high performance change of standing posture (CSP) detector (Shih, Shih, & Chiang, 2010) and a wireless object location detector (Shih & Chang, 2012b). A Nintendo Wii Remote Controller with a three-axis accelerometer sensor was applied as a precise limb action detector (Shih, Chang, & Shih, 2010), head position/angle detector (Shih, Shih, et al., 2011), and three-dimensional object orientation detector (Shih, Chang, et al., 2012). A gyration air mouse with gyroscope sensor was used to serve as a precise limb action detector (Shih, Chang, & Shih, 2010), and a battery-free wireless mouse (Radio Frequency Identification – RFID sensor) was modified to make it an object location detector (Shih, 2011b). The keyboard is one of the basic input devices for computers. It is a typewriter-style device with an arrangement of keys, and each press of a key corresponds to a character, number, sign or command (Wikipedia, 2014). Based on these characteristics, the keyboard can be regarded as a device embedded with multiple switch sensors, and can detect the status of the individual key which was pressed or released. From a special education or rehabilitation perspective, a keyboard device can be used as a special finger-pressing position detector that can detect the fine pressing behavior of fingers, but the premise is that certain technical ability is required to modify the default functions of a keyboard device. Since a keyboard is a standard device for a computer, its driver is already built into the computer operating system (OS). Once the keyboard is connected to the computer, the OS will identify it as a keyboard device and will install its driver automatically. Hence, to change the functionality of keyboard devices for use in special education or rehabilitation, the assistance of new driver software is necessary. Shih (2012) used software technology to develop a finger-pressing position detection program (FPPDP) to modify the keyboard driver in order to reset a keyboard’s default functions. FPPDP is able to intercept keyboard actions and turn a standard keyboard into a high performance finger-pressing position detector. In this previous study, two participants had to use their fingers to point correctly at one of the two pre-defined keys, and then point at the other one after about 6 s to trigger their preferred stimulation. The experiment results were positive and participants’ correct target responses were significantly increased during the intervention phase. This study extended the research into FPPDP application (Shih, 2012) and was conducted on two students with developmental disabilities and fine motor difficulties in order to evaluate whether they could actively perform fine motor activities by controlling their favorite stimulation using a wireless keyboard. More complex fine motor skills were required in this experiment, in the sense that participants needed to correctly press three pre-defined keys with their three fingers simultaneously on the keyboard. After the stimulation was triggered for 6 s, they needed to move their fingers to point to three other pre-defined positions on the keyboard at the same time. 2. Methodology 2.1. Participants The participants, Liu and Wang, were 18 and 16 years of age, respectively. Both were rated as possessing moderate intelligence, with profound multiple disabilities including difficulties with communication due to cerebral palsy, poor fine finger motor skills, and slowness of movement. Liu had no vocal ability, and could only express himself by nodding and shaking his head. Wang spoke little, but liked interacting with people. Their vision and hearing were normal with good auditory comprehension and both participants understood all statements. They both had experience using computers, and liked watching movies/videos, which meant that these could be used as participants’ preferred environmental stimulation. Both personalities were gentle and both participants had a willingness to learn. After receiving guidance from the research assistant, both participants could understand that they needed to move their fingers to point to correct positions in order to trigger the interesting stimulation. Both participants’ parents were informed of and agreed to allow their children to participate in this study. 2.2. Target response, keyboard setting, and control system The configuration of this study included: (a) a control system (a minicomputer) with FPPDP software installed, (b) a largesize TV was used to play participants’ favorite videos (environmental stimulation), as shown in Fig. 1, (c) six pre-defined positions were set up on the ‘‘E’’, ‘‘S’’, ‘‘X’’, ‘‘-’’, ‘‘P’’, and ‘‘[’’ keys of a wireless keyboard, and were marked as P1, P2, P3, P4, P5, P6 with red-colored stickers, as shown in Fig. 2.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
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Fig. 1. A control system (Eee Box minicomputer) with FPPDP software installed was connected to a TV to play participants’ preferred environment stimulation.
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Fig. 2. Six pre-defined positions P1, P2, P3, P4, P5 and P6 were marked with red stickers so participants could quickly identify the positions on the keyboard.
In this study, the target response was a sequence of participants’ fine motor activities. First, participants had to precisely point to three pre-defined positions – P1, P2, and P3 with their three fingers at the same time. If a valid response was detected, participants would be rewarded with their favorite environmental stimulation. The stimulation would be continued for 6 s and then stopped. Next, participants had to move their fingers to the other three pre-defined positions – P4, P5 and P6, pressing the three keys simultaneously to perform a new valid target response in order to trigger a new 6 s stimulation. This action was repeated until the end of the experiment. The stimulation consisted of the participants’ favorite videos, provided by their parents. In order to detect the target responses, a standard wireless keyboard was used to detect keyboard keystroke status and transmit this data via wireless to the control system. In this study, an ASUS Eee Box minicomputer (ASUS, 2013) was used as a control system. The Eee Box minicomputer was a standard Windows Operating System (OS) computer with FPPDP software installed in order to disable the standard keyboard functions and distinguish which key had been pressed or released. 2.3. Experimental conditions This study used an ABAB design, where A represented the baseline and B represented intervention phases (Richards et al., 1999). Both participants underwent three to five 3-min experimental sessions per day at their school, and experimental data were automatically recorded by the control system. 2.3.1. Baseline phases The participants underwent 18 and 12 sessions, respectively, during the baseline phase. All the devices were available, but no simulation would be triggered, even though participants performed a correct response during this phase. Both participants would receive vocal promptings from a research assistant to perform responses if they did not perform a valid response within 1 min. 2.3.2. Intervention phases The participants underwent 48 and 42 sessions, respectively, during the intervention phase. The setting was the same as in the baseline phase, but the stimulation would be triggered during this phase whenever participants performed a correct response.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
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Fig. 3. Liu’s data. Each data point on the graph represents an average of three experimental sessions.
Fig. 4. Wang’s data. Each data point on the graph represents an average of three experimental sessions.
2.4. Results Experimental data of participant Liu are shown in Fig. 3. In the first baseline phase, Liu had an average of about 3.67 correct responses per session. In the first intervention phase, the average number of responses increased to 19.75 responses per session. The average dropped to 2.75 during the second baseline phase and then increased again to 20.29 in the second intervention phase. The differences in correct response frequencies between the baseline and the intervention phases were significant (p < 0.01) based on the Kolmogorov–Smirnov test (Siegel & Castellan, 1988). Experimental data of participant Wang is shown in Fig. 4. Wang had an average of 2.83 valid responses per session in Baseline I, while the number of correct target responses increased to 15.94 per session in Intervention I. The average value dropped to 3.50 during Baseline II and then increased to 17.79 for Intervention II. The differences between the baseline responding frequencies and the intervention responding frequencies were also significant (p < 0.01) based on the Kolmogorov–Smirnov test (Siegel & Castellan, 1988). According to the experimental results from Figs. 3 and 4, both participants did not have much willingness to carry out the assigned fine motor activities during the baseline phases, and the number of correct responses per session was low during this phase. But during the intervention phases, due to the intervention of preferred environmental stimulation, participants showed a high willingness to perform fine motor activities and the number of valid responses per session increased rapidly. 3. Discussion The keyboard is a precision device, designed to be used as an input device for a computer, and can precisely detect the status of each key pressed or released. With the assistance of software technology, the applications of a standard keyboard can be altered (Shih, 2012). In this study, we adopted the previously developed FPPDP software to extend the default functions of a keyboard device, turning it into a high performance assistive device (i.e. a finger-pressing position detector) for detecting fine motor activities. The experiment was designed so that participants needed to press three keys with their three fingers at the same time on the keyboard and needed to move their hands from one side of the keyboard to the other side. Those motions can improve their finger control ability, increase their body coordination, and enhance their confidence and self-esteem. According to the experimental results, both participants increased their willingness to control the stimulation through performing assigned fine motor activities, and had significantly increased the number of correct target responses which triggered their favorite stimulation during the intervention phase.
Please cite this article in press as: Chang, M.-L., & Shih, C.-H. Improving fine motor activities of people with disabilities by using the response-stimulation strategy with a standard keyboard. Research in Developmental Disabilities (2014), http:// dx.doi.org/10.1016/j.ridd.2014.04.011
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All devices used in this study were standard devices and could be easily obtained. There are many advantages of using standard devices, such as low cost, ready availability, good technical support, the fact that various models can be chosen, etc. Besides the keyboard, there are many other precision devices that can also be used as assistive technology devices. The application of software technology can be a way to apply these devices in the fields related to helping people with disabilities and other special needs. The results show that subjects exhibited great improvement in terms of fine motor activities, but this study only focused on two students with developmental disabilities who could perform fine motor activities by using a standard keyboard through environmental stimulation, and people with different types of disabilities were not addressed here. In further studies, more applications need to be considered for other people with multiple disabilities. In addition, future experiments can be carried out by arranging more complex fine motor activities and using more than one keyboard. Hopefully, the implementation of a standard keyboard can provide disabled people with more options when it comes to assistive technology and make such assistance affordable in educational and home contexts. Acknowledgements The authors would like to thank the National Science Council, Taiwan, ROC for financially supporting this research under Contract No. NSC 102-2511-S-259-012. References ASUS. (2013). Eee Box mini computer Retrieved from http://www.asus.com/Eee_Box_PCs/EeeBox_PC_EB1021/.. Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Oliva, D., Coppa, M. M., & Montironi, G. (2005). A new microswitch to enable a boy with minimal motor behavior to control environmental stimulation with eye blinks. Behavioral Interventions, 20, 147–153. Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Oliva, D., Scalini, L., Vigo, C. M., et al. (2005). 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