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Research Report
Helping Three Persons with
Multiple Disabilities Acquire
Independent Dressing Through
Assistive Technology
Giulio E. Lancioni, Mark F. OReilly,
Nirbhay N. Singh, Jeff Sigafoos, Doretta
Oliva, Francesca Campodonico, and
Jop Groeneweg
Enabling persons with intellectual or multi-
ple disabilities to carry out personal care tasks
(such as washing and dressing) independent
of guidance from parents or staff members
and without prolonged interruptions is a rel-
evant educational objective (King-Sears &
768 Journal of Visual Impairment & Blindness, December 2007
odonico, & Mantini, 2001; Sewell, Collins,
Hemmeter, & Schuster, 1998). Achieving
such an objective is often difficult, particu-
larly with persons whose disabilities also in-
clude visual impairments (Lancioni et al.,
2006), and staff or parental guidance may
continue to be needed (King-Sears & Carpen-
ter, 2005). This guidance can be time con-
suming for staff members or parents and neg-
ative for the social image of individuals
because it emphasizes their dependence on
others (Lancioni, OReilly, & Campodonico,
2002).
Attempts were recently made to curb the
problem of dependency in personal care tasks
with the use of assistive technology, which
ensured a combination of verbal prompting
and preferred stimuli that were automati-
cally delivered on positive performance (see
Lancioni et al., 2002, 2006). Three partici-
pants were involved in the intervention pro-
grams described in these studies, and they all
learned to dress themselves. Although these
results are encouraging, two aspects of the
technology that was used in the interven-
tions raise some questions. First, prompts
were delivered at preset intervals, rather
than upon the failure to respond of partici-
pants. The latter condition would appear
preferable in terms of effectiveness and
respect for the dignity of participants
(Lancioni, OReilly, Seedhouse, Furniss,
& Cunha, 2000). Second, the prompts and
reinforcing stimuli were all auditory. The
possibility of using various types of
prompts and reinforcing events would be
essential for the generalizability of the
approach.
The goal of the study presented here was to
help three new participants with multiple dis-
abilities acquire independent dressing through
an upgraded version of the technology. This
technology provided prompts only for the
failure to respond and included auditory,
2007 AFB, All Rights Reserved
visual, and vibratory stimuli as reinforcing
events or prompts.
METHOD
Participants
The participants, Sylvie, Floyd, and Alan
(all names are pseudonyms), were 37, 27,
and 29 years old, respectively. They had
encephalopathy with a level of functioning
estimated to be in the profound range of
intellectual disability. Their age equivalents
for their daily living skills were about 3
years or younger on the Vineland Adaptive
Behavior ScalesInterview Edition (Spar-
row, Balla, & Cicchetti, 1984). Sylvie was
deaf and had minimal residual vision that
allowed her to enjoy light displays and find
fairly large objects within about 1 meter
(about 39 inches) in front of her and at the
center of her visual field. Floyd was totally
blind and had typical hearing. Alan was
totally blind and deaf and, contrary to the
other participants, nonambulatory. These
differences in sensory-motor conditions
(representative of common variations
among individuals with multiple disabili-
ties) allowed for adaptations and a broader
evaluation of the assistive technology used
in the intervention presented here. All three
participants were considered capable of
performing the steps of the dressing task,
even though Alan needed some physical
support to complete the responses of put-
ting on his underpants and pants because of
his physical condition. In spite of their gen-
eral abilities, the three participants still
tended to have breaks in performance that
required interventions by staff members.
Approval for this research was granted by
the Scientific and Ethics Committee of the
Lega F. DOro, Osimo, Italy. The partici-
pants were not capable of signing an in-
formed consent form, so their parents did it
for them in accordance with Italian law.
2007 AFB, All Rights Reserved
Setting, dressing task, recording,
and reliability
The study was carried out in the participants
bedrooms by research assistants who were
familiar with the topic of personal care tasks
and the delicate issue of respect for the par-
ticipants dignity. Sylvies dressing sequence
consisted of taking and putting on her under-
pants, undershirt, one sock, the other sock,
T-shirt, pants, pullover sweatshirt, right shoe,
and left shoe. For Floyd and Alan, the se-
quence did not include the sweatshirt. The
number of items put on by the participants
independent of the research assistants verbal
or physical guidance (which excluded the
aforementioned physical support for Alan)
and the time required to complete the task
were recorded. Interrater reliability was
checked in about 20% of the participants
dressing occasions. Agreement, which al-
lowed for a discrepancy of 30 seconds for the
task time and required the same indepen-
dent or dependent score on each task item,
occurred in more than 92% of the occasions
that were checked.
Positions of the participants and items
Sylvie and Floyd sat on a chair in front of a
dresser that held all the items required for
dressing. Alan sat beside (in contact with) a
low table with a large container on it. At the
bottom of that container, there was a shoebox
with his shoes. On top of the shoebox, there
were his clothing items. For Floyd, his under-
pants, undershirt, first sock, second sock,
T-shirt, pants, right shoe, and left shoe were
distributed (from top to bottom) in the eight
drawers of the dresser. For Sylvie, who had a
ninth item (a pullover sweatshirt), both shoes
were in a single drawer. All the dresser draw-
ers were open at the start of the task, and
Floyd and Sylvie were able to access only the
top drawer and take the first item (under-
pants). Then, they would close the drawer and
put on the item. Their next response consisted
of accessing the top drawer of the seven still
Journal of Visual Impairment & Blindness, December 2007 769
open, taking the second item, and then putting
it on. The same process was repeated at each
of the following drawers. For Alan, the cloth-
ing items were piled inside the container, with
the underpants on top and the pants at the
bottom of the pile (above the shoebox with
the shoes).
Technology and stimuli
The technology that was used for Sylvie
involved an optic sensor linked to an elec-
tronic control system, which regulated a
multicolor light display and a mini-vibrator.
The optic sensor was placed on top of the
dresser and was activated when Sylvie re-
moved an item from a drawer, thus uncov-
ering reflecting material that was attached
to the bottom of the drawer. This activation
led the control system to turn on the pre-
ferred light display for 14 seconds. Sylvies
failure to remove an item after a period of
about 60 seconds led the control system to
activate a mini-vibrator (prompt), which
Sylvia wore at her wrist, for 5 seconds. The
vibrator and control system were linked by
radio signals. If Sylvie did not respond to
the vibration within 10 seconds by remov-
ing an item from a drawer, a new vibratory
event occurred. Sylvies failure to respond
to this second event led to the use of phys-
ical guidance by a research assistant.
The technology used for Floyd varied from
that described for Sylvie only in that the con-
trol system was linked to two tape players,
which presented 14 seconds of preferred mu-
sic, songs, or excited praise at the removal of
an item from the drawer, and a verbal encour-
agement (prompt) if he failed to respond. The
technology used for Alan included an optic
sensor fixed to the container on the table.
Activating the sensor, through the removal of
a clothing item or shoe from the container, led
the control system to turn on preferred vibra-
tory stimulation at the back of Alans chair for
14 seconds. Alans failure to remove a cloth-
ing item or a shoe for a time period of about
770 Journal of Visual Impairment & Blindness, December 2007
60 seconds led the control system to activate
a pulse-vibrator (prompt) attached to the table
for 4 or 5 seconds.
The stimuli that occurred on the removal of
the items from the dresser or container and
that were considered preferred by the partic-
ipants (lights for Sylvie; music, songs, and
praise for Floyd; and vibration at the back of
the chair for Alan) were selected following
advice from the staff and a brief screening.
The screening consisted of presenting the
stimuli recommended by the staff to the par-
ticipants at least 10 times nonconsecutively.
Only those stimuli that produced positive re-
actions (such as alerting, orienting, or smil-
ing) in more than two-thirds of the presenta-
tions were retained for the study.
Experimental conditions
The study was conducted according to a mul-
tiple baseline design for all the participants
(Richards, Taylor, Ramasamy, & Richards,
1999). Consistent with the conditions avail-
able prior to the study, Sylvie had one dress-
ing occasion per day (morning), and Floyd
and Alan had two dressing occasions per day
(morning and afternoon). The performance of
the participants for the various items of the
dressing task was scored as independent when
the item was put on without guidance from a
research assistant (with the aforementioned
exceptions for Alan) and dependent when it
required guidance.
Baseline. The baseline condition included
6, 14, and 18 dressing occasions for the three
participants (Sylvie, Floyd, and Alan), re-
spectively. The positions of the participants
and the dressing items were as was described
earlier. However, during the baseline phase,
the technology used in the intervention phase
was not available, and guidance by a research
assistant occurred if a participant had a break
in performance of 60 120 seconds.
Intervention. The intervention condition
included 81, 156, and 140 dressing occa-
sions for the three participants (Sylvie,
2007 AFB, All Rights Reserved
Figure 1. Data for Sylvie, Floyd, and Alan. The black triangles represent mean percentages
of dressing items put on independently over blocks of two dressing occasions (only the last data
point of Sylvies intervention includes a single occasion). The circles represent the mean amount
of time (in minutes) required for performing the dressing sequence for the same periods of time
or blocks of occasions.

Floyd, and Alan), respectively. These occa-
sions were spread over periods exceeding
3.5 months. Procedural conditions differed
from those used during the baseline in that
the technology was available and worked
as was specified earlier.
RESULTS
The three graphs of Figure 1 summarize the
data for the three participants during the base-
line and intervention periods. During the
baseline, the participants (Sylvie, Floyd, and
Alan) put on independently about 60%, 50%,
and 30% of the dressing items, respectively.
Their average times for completing the se-
quence were 8 to 13 minutes. During the
intervention, each participant became capable
of performing the dressing sequence with
only occasional guidance from the research
assistants, and the time they required to per-
form it decreased markedly. The mean
amount of time required for the dressing task
during the second half of the intervention
periods was fewer than 6 minutes for all the
participants. The differences in the percent-
ages of dressing items put on independently
and the amount of time required for dressing
between the baseline and intervention were
statistically significant for all the participants
(p .01) on the Kolmogorov-Smirnov test
(Siegel & Castellan, 1988).
DISCUSSION
The data, which largely support and extend
those that were previously reported in this
area (Lancioni et al., 2002, 2006), appear

2007 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, December 2007 771
encouraging with regard to the possibility of
using technological solutions to promote
daily self-help skills (see, for example,
Lancioni, Smaldone, OReilly, Singh, &
Oliva, 2005; Wilson, Reid, & Green, 2006).
The technology that was applied in this study
allowed the use of various types of preferred
stimuli as plausible reinforcing events and
provided prompts only following the partici-
pants failure to respond. The former option
can be viewed as critical for generalizing the
use of the technology to persons with differ-
ent characteristics, preferences, and physical
or sensory conditions (Sewell et al., 1998).
The latter option can be considered important
for increasing the effectiveness of the prompt
while reducing its fixed-interval (often irrel-
evant) occurrence and promoting social im-
age and independence of the participants (see,
for example, Lancioni et al., 2000; Wilson
et al., 2006). Informal reports suggested that
prompts continued to occur, albeit at rela-
tively low (sporadic) levels, through the final
stages of the intervention, with usually suc-
cessful outcomes.
The innovative aspects of the technology
and the fact that it seems simple to apply by
parents and staff may allow the technology to
be adopted within the home and care contexts
(Copley & Ziviani, 2005; Parette, 1997). The
cost of the technology (about U.S. $1,200),
however, may be excessive for some. To mit-
igate the cost issue, one may argue that such
technology could be used for a long period of
time without extra expenses and could be
shared among participants.
Whether participants would eventually be-
come independent of the technology remains
an open question. Persons with multiple dis-
abilities may more easily maintain high mo-
tivation and fluency in performance with the
preferred stimuli and occasional prompting
that the technology provides (Lancioni et al.,
2000, 2005; Scherer, 2005). Researchers may
need to conduct direct and systematic repli-
cations of this study to clarify the aforemen-
772 Journal of Visual Impairment & Blindness, December 2007
tioned question and to refine the technology
and its general applicability.
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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: g.
lancioni@psico.uniba.it. Mark F. OReilly,
Ph.D., professor, Department of Special Educa-
tion, University of Texas at Austin, Mail Code D
5300, Austin, TX 78712; e-mail: markoreilly@
mail.utexas.edu. Nirbhay N. Singh, Ph.D.,
senior scientist, ONE Research Institute, P.O.
Box 4657, Midlothian, VA 23112; e-mail:
nirbsingh52@aol.com. Jeff Sigafoos, Ph.D.,
School of Education, University of Tasmania,
Hobart, Tasmania 7001, Australia; e-mail:
jeff.sigafoos@utas.edu.au. Doretta Oliva,
M.A., research coordinator, Lega F. DOro Re-
search Center, Via Montecerno 1, 60027 Osimo,
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Francesca Campodonico, B.A., research
assistant, Lega F. DOro Research Center;
e-mail: campodonico.f@legadelfilodoro.it. Jop
Groeneweg, Ph.D., assistant professor, Depart-
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e-mail: groeneweg@fsw.leidenuniv.nl. Ad-
dress all correspondence to Dr. Lancioni.
Journal of Visual Impairment & Blindness, December 2007 773