Microswitch Intervention Program May Benefit Children with Rett Syndrome, Study Suggests

Microswitches can be used as assistive technology to help improve choice-making and activity engagement in children with Rett syndrome, according to a recent study.

Led by researchers in Italy, the study “Experimental Examination and Social Validation of a Microswitch Intervention to Improve Choice-Making and Activity Engagement for Six Girls with Rett Syndrome,” was published in Developmental Neurorehabilitation.

Rett syndrome is a genetic disorder that is characterized by several cognitive and developmental impairments, including lack of spoken language, severe-to-profound intellectual disability, and motor deterioration.

When compared to typically developing children, those affected by Rett also may experience withdrawal, isolation, and passivity, which may contribute to  poorer quality of life.

Researchers have focused on finding new ways to help reduce the negative effects of Rett-related disabilities on children’s quality of life. In particular, the use of assistive technology has proven to be an effective way to lessen the impact of the disease by facilitating access to meaningful activities and reducing social isolation.

With this in mind, researchers explored the beneficial effects of technological supports (i.e., microswitches as optic sensors), computers, and adapted software to improve choice-making and constructive engagement among six girls with Rett syndrome.

All girls were asked to insert a familiar object — a little doll, a little car, or a little box — into one of three rectangular containers that were placed in front of them. Each of these containers was equipped with two sensors that detected the object that was placed inside, and included a rectangular colored picture of a doll, a car, and a box, respectively.

The three objects were mixed with other familiar objects, meaning that the girls had to choose the right object from among all those they could freely access.

If the object-container pair was correct, the girl would receive a positive stimulus as a reward, such has a preferred video, colored lights, or pleasant songs, which were delivered randomly.

“[T]he delivered preferred stimuli were counterbalanced across the boxes and the position of boxes were also counterbalanced to account for potential positional preference,” the researches explained.

So, the girls had to correctly match the objects with the corresponding container, but also match them according to the reward that they would prefer to get. “This was a new adaptive behavior which was highly appreciated by the parents and considered a valid educational and rehabilitative resource by caregivers and teachers,” researchers noted.

These sessions typically would take about 10 minutes, and all participants would undergo three sessions per day, five days per week. The technology used costed approximately $1,000 for each participant.

In general, each participant showed improved performances throughout time, demonstrating that the intervention had a beneficial effect on the girls’ adaptive responses. Five participants showed a capacity for independent and selective choice, while the behavior of one girl seemed to be closely linked to the position of the container.

“Our findings emphasized that the assistive technology-based rehabilitative program was effective and suitable (…) teaching choice-making to children with Rett syndrome and severe to profound developmental disabilities,” the researchers wrote.

In addition, the girls’ proof of happiness was linked closely to their performance and were significantly higher during intervention phases when compared to their mood status before the intervention. This suggests that the children enjoyed the sessions and had feelings of pleasure, well-being, and fulfilment linked to the program.

A new assessment after an interruption of the program for six months showed that all the skills that had been learned were retained, and the girls’ performance remained unchanged.

Ninety external evaluators, which included 30 caregivers, 30 parents of children with developmental disabilities, and 30 psychologists who worked with people with intellectual disabilities, endorsed the use of the program based on the potential positive outcome and its feasible implementation.

Supported by these results, the team believes that a “microswitch intervention may be a suitable and cost-effective intervention for teaching choice making, and object sorting to children with Rett syndrome.”