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OBM Neurobiology

(ISSN 2573-4407)

OBM Neurobiology is an international peer-reviewed Open Access journal published quarterly online by LIDSEN Publishing Inc. By design, the scope of OBM Neurobiology is broad, so as to reflect the multidisciplinary nature of the field of Neurobiology that interfaces biology with the fundamental and clinical neurosciences. As such, OBM Neurobiology embraces rigorous multidisciplinary investigations into the form and function of neurons and glia that make up the nervous system, either individually or in ensemble, in health or disease. OBM Neurobiology welcomes original contributions that employ a combination of molecular, cellular, systems and behavioral approaches to report novel neuroanatomical, neuropharmacological, neurophysiological and neurobehavioral findings related to the following aspects of the nervous system: Signal Transduction and Neurotransmission; Neural Circuits and Systems Neurobiology; Nervous System Development and Aging; Neurobiology of Nervous System Diseases (e.g., Developmental Brain Disorders; Neurodegenerative Disorders).

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Open Access Research Article

Technology Support to Enable People with Severe Intellectual Disability and Blindness to Carry Out Occupational Activities and Transition Between Them Independently

Giulio E. Lancioni 1,*, Gloria Alberti 1, Chiara Filippini 1, Nirbhay N. Singh 2, Mark F. O’Reilly 3, Jeff Sigafoos 4

  1. Lega F. D’Oro Research Center, Osimo (AN), Italy

  2. Augusta University, Augusta GA, USA

  3. University of Texas at Austin, Austin TX, USA

  4. Victoria University of Wellington, Wellington, New Zealand

* Correspondence: Giulio E. Lancioni

Academic Editor: Fady Alnajjar

Received: July 14, 2025 | Accepted: September 29, 2025 | Published: October 09, 2025

OBM Neurobiology 2025, Volume 9, Issue 4, doi:10.21926/obm.neurobiol.2504303

Recommended citation: Lancioni GE, Alberti G, Filippini C, Singh NN, O’Reilly MF, Sigafoos J. Technology Support to Enable People with Severe Intellectual Disability and Blindness to Carry Out Occupational Activities and Transition Between Them Independently. OBM Neurobiology 2025; 9(4): 303; doi:10.21926/obm.neurobiol.2504303.

© 2025 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

Abstract

People with severe intellectual disability and blindness tend to perform only simple occupational activities and are mostly unable to transition between those activities. This inability makes their level of occupation independent of staff support fairly limited. Technology-aided programs may be one of the few opportunities available to increase their independent occupation. This study assessed one such program designed to (a) monitor the participants' responses and guide them to transition to a new activity once the previous activity had been completed, (b) ensure the presentation of brief periods of preferred stimulation contingent on the participants' responses during the activities (i.e., to increase their engagement motivation), and (c) provide verbal encouragements/prompts if the participants failed to respond within a preset time interval. Each session included a sequence of eight or nine activities (e.g., placing glasses in a glass holder box) to be carried out at eight or nine different desks. The technology included a smartphone fitted with a commercial and a dedicated application, a series of barcodes, a barcode reader, and mini speakers. The study included six participants and was carried out using single-case research methodology. During the baseline (without the system), the participants' mean percentage of objects used (out of those available for the activities) varied between about 33 and 71. Their mean percentage of desks/activities reached independently was zero except in one case. During the intervention (with the system), the participants managed to use between about 97 and nearly 100% of the objects available for the activities and to transition between the activities independently (i.e., with the mean percentage of desks/activities reached independently varying from about 98 to nearly 100%). These findings seem to be encouraging as to the possibility of helping people with severe intellectual disability and blindness manage constructive occupation. Caution may, however, be required in drawing conclusions given the limitations of the study (e.g., a relatively small number of participants and lack of maintenance and generalization data).

Keywords

Smartphone; barcodes; barcode reader; intellectual disability; blindness; occupational activities

1. Introduction

A main objective of intervention programs for people with intellectual or multiple disabilities is to promote constructive activity engagement [1,2,3,4,5]. The nature of this engagement changes according to the characteristics of the people involved. For people with mild-to-moderate intellectual disability, for example, the intervention goal is to enable them to manage multistep activities (e.g., daily living tasks and tasks with vocational potential), and instruction systems are frequently used to support their performance [6,7,8,9,10]. Instruction systems tend to be portable devices (e.g., smartphones and tablets) [8,9,11,12,13,14,15]. Strategies such as the use of visual or video activity schedules [16,17,18,19,20] are also adopted to help them transition between activities and thus increase their independence and functional adjustment to the living or working context.

People with severe intellectual disability or multiple disabilities (e.g., severe intellectual disability and visual impairment or blindness) are more likely to be involved in simple forms of occupational activities [21,22,23,24,25]. These activities may entail the repetition of few simple actions with a series of common objects (e.g., placing bottles in a crate or on a shelf or storing glasses in a glass holder box). Resorting to simple activities is typically motivated by the fact that most of these people possess only simple response schemes, can handle only some objects/materials, and are unlikely to follow specific step instructions (i.e., instructions concerning a sequence of different actions/steps).

A problem with the use of these activities is that each of them may last a fairly short time. In fact, the number of objects available for an activity at a specific desk or other work station may need to be limited given the participants' problems in searching for objects over a large surface/space. To ensure that the participants remain engaged for a reasonable (practically relevant) amount of time and in a non-repetitive manner, one would need to schedule a series of activities and ensure that the participants carry them out in sequence. The material for the different activities could be available on separate desks (or work stations) to avoid object confusion and ensure that the participants would walk from one activity to the next thus countering their tendency to be sedentary.

While the aforementioned activity arrangement may be considered useful, the possibility of making it work with these participants would depend on the ability to overcome three of their most likely problems, that is, (a) tendency to have discontinuous performance, (b) difficulties in moving from one activity to the next (e.g., due to lack of self-determination and poor orientation skills), and (c) low motivation to be involved in the activity [26,27]. Programs to address those problems would need to be strictly supervised by staff personnel or supported by technology. Given the usually reduced staff resources available in contexts directed at the rehabilitation and care of people with severe intellectual and multiple disabilities, the use of technology may be indispensable for the implementation of such programs [1,11,28,29].

A program supported by technology was reported by Lancioni et al. [30]. The program was designed to help three participants carry out six simple activities at six different desks, which were at a distance of about 2 meters from one another. The technology consisted of a control device linked to sound boxes and optic sensors available at all desks except the first. At the start of a session, the participants were accompanied to the first desk where they found the objects for the first activity. At the end of a preset time interval (i.e., an interval of about 1 min was considered sufficient for the participants to complete the activity), the sound box available at the second desk started to call them to that desk. As soon as they reached that desk, the sound box emitted praise sentences. The participants were then to use the objects available for the second activity. The same process was repeated for each of the following desks/activities. After the last activity, the participants were provided with preferred stimulation. The results were encouraging with the participants managing to carry out the activities available and transition between them. Yet, two program limitations were also clear. First, the sessions lasted about 8 min so they only ensured a short occupation time. Second, the calls to the next desk programmed at preset time intervals could occur prematurely (i.e., when the participants were still performing the activity) or could be late (i.e., once the participants had already completed the activity for some time) as they did not take into consideration the variability in the participants' performance speed.

The present study assessed a technology-aided program designed to (a) address the limitations of the aforementioned program (i.e., by promoting longer occupation periods and guiding the transition between activities based on participants' performance rather than on preset time intervals), (b) ensure the presentation of brief periods of preferred stimulation contingent on the participants' responses during the activities (i.e., to increase their engagement motivation), and (c) provide verbal encouragements/prompts if the participants showed periods of no responding. The technology, which was selected on the basis of its accessibility, affordability and simplicity, included a smartphone fitted with a commercial and a dedicated application, a series of barcodes, a barcode reader, and mini speakers. Eight or nine activities (e.g., placing glasses in a glass holder box) were available during the sessions. Six participants were included in the study, which was based on single-case research methodology. Specifically, the study started with a baseline phase during which the aforementioned technology-aided program was not in use, and continued with an intervention phase during which the program and the related technology were available throughout the sessions. The hypothesis was that the program (i.e., with the support of the technology) would enable the participants to use the objects available for the activities (completing the activities) and transition from one activity to the next independently.

2. Method

2.1 Participants

Table 1 lists the participants with the pseudonyms of Luke, Avery, Jacob, Travis, Hudson, and Rowan, and reports their chronological ages and their Vineland age equivalents calculated via the second edition of the Vineland Adaptive Behavior Scales [31,32]. Their chronological ages ranged between 26 and 53 years. Their Vineland age equivalents ranged between 2 years and 8 months and 3 years and 3 months for Daily Living Skills (personal sub-domain) and between 1 year and 7 months and 2 years and 10 months for Receptive Communication. All participants had a diagnosis of congenital encephalopathy with intellectual disability and blindness. Hudson also presented with mild-to-moderate hearing loss that did not prevent him from enjoying music and responding to verbal encouragements. Their level of intellectual disability estimated by the psychological services of the rehabilitation and care centers that the participants attended was severe.

Table 1 Participants' chronological age and Vineland age equivalents for Daily Living Skills Personal sub-domain (DLSP) and Receptive Communication (RC).

The participants were deemed to represent a convenience sample [33] as they were attending rehabilitation and care centers belonging to the same organization. They were recruited for the study on the basis of several conditions that had been verified in advance through observations and staff interviews. First, they tended to be passive and sedentary. Second, they were capable of carrying out simple activities involving the repetition of few responses with series of objects (e.g., placing bottles in crates). However, they could have breaks in performance interfering with their completion of the activities. Third, they required help to transition from one activity to the next. Fourth, they were able to respond to simple verbal prompts/encouragements (e.g., could resume the use of objects after a break). With the exception of Hudson, they could also orient to and reach a target place based on verbal/spatial cues originating from that place. Fifth, they seemed to enjoy music stimulation and the assumption was that this type of stimulation could be used during the study (i.e., contingent on their responses). Sixth, staff personnel, who were informed about the study in advance, expressed their support for it.

2.2 Ethical Considerations

Staff personnel considered the participants' involvement in the study a useful and pleasant experience for them. In fact, they could pursue the goal of independent activity engagement (i.e., a goal highly appreciated within their rehabilitation and care context) and also enjoy the stimulation available during their engagement. While staff were positive about the study, no opinion about (consent for) it could be gathered from the participants given their condition. The participants' legal representatives shared the staff's positive opinion about the study and signed consent forms on the participants' behalf.

2.3 Setting, Activity Material, Sessions, Research Assistants, and Music Stimulation

The study was carried out in two or three adjacent rooms of the rehabilitation and care centers that the participants attended. Totals of nine desks (Rowan) or eight desks (all other participants) were distributed in the rooms with the distance between desks never less than 2 meters. Each desk contained the material for one activity. The material consisted of a series of 8-18 objects (e.g., glasses, dishes, jar lids, and bottles), which were available inside a container and were to be collected by the participants and used in relation to a second series of objects (e.g., a group of jars) or a single referent object (e.g., a dish drainer). For example, the participants could take from the container (a) bottles and place them in bottle crates, (b) dishes and place them in a dish drainer, (c) glasses and place them in a glass holder box, and (d) jar lids and place/screw them on a series of jars.

Sessions involved the performance of the activities on the different desks and the transition between desks (i.e., moving from a desk where the activity had been completed to the next desk of the sequence to carry out the next activity). The participants were typically involved in one session per day, 4 to 6 days a week. The sessions were implemented by four research assistants who had a university degree in psychology and were experienced in using technology-aided programs and recording data with people with disabilities.

Brief segments of songs and music pieces were used during the intervention sessions (i.e., when the technology system was available). The songs and music pieces, which were recommended by staff, were selected for the study through a stimulus preference screening procedure. This procedure involved at least 10 nonconsecutive presentations (i.e., over different screening periods) of three 5-10 s segments of each song or music piece. A song or music piece would be retained for the study when the research assistant and staff person involved in the screening agreed that the participants reacted positively (e.g., with smiles and orienting) to at least 50% of the segment presentations.

2.4 Technology System - Components

The technology system included (a) a smartphone working on Android, (b) eight or nine barcodes used to identify the eight or nine desks/activities available in the sessions, (c) a barcode reader, and (d) eight or nine mini speakers except in the case of Hudson who used only one mini speaker (see below). The smartphone, which was in a remote position during the sessions, was fitted with the MacroDroid application and a special (dedicated) application. The MacroDroid application served for the activation of the mini speakers (mini speaker for Hudson) and the delivery of positive stimulation during the activities. The special application served (a) for counting the participants' responses (i.e., the objects collected from the containers on the desks) and so determining when an activity was completed, and (b) for controlling the presentation of prompts/encouragements to carry out the activity (in case the participants were not responding for a preset time) and to walk to the next desk (once the participants had completed an activity).

The barcodes were produced through a free online barcode generator (https://barcorcode.tec-it.com) and printed on A-4 (29.7 × 21.0 cm) sheets of paper. Sheets of paper with a specific barcode were fixed to the container with the objects to be used for the activity available on each of the desks (see Figure 1). The barcode reader was a commercial device (NETUM Bluetooth 2D Barcode Scanner available via Amazon). It was fixed on the participants' right wrist (as they used the right hand to collect the objects from the containers), was on a continuous scanning mode, and worked in connection with the smartphone. Specifically, it served as a sensor to detect the participants' object collection (i.e., from the containers) and inform the smartphone about that.

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Figure 1 Container for the objects to be used for the activities, paper sheets with barcode reproductions fixed to the container, and barcode reader on the participants' right wrist.

The mini speakers were displayed on the desks (one per desk) for all participants except Hudson. Hudson had the only mini speaker he used at his shoulder. The special application, which is freely available (https://osf.io/mfw7t/?view_only=ed094a48b4584c37ba8f2a55f3452c6f), was developed via Reactive Native Framework. This application allowed the research assistants to program the number of times each barcode needed to be read by the barcode reader (i.e., the same number as the objects the participants were to collect and use) to consider an activity completed. If an activity included 12 glasses to be placed in a glass holder box, for example, the number of barcode readings programmed for it was 12. Based on this programming, the system considered the activity completed when the barcode reader on the participants' wrist had read the barcode fitted to the container with glasses 12 times (i.e., when the participants had presumably collected the 12 glasses available). The special application also ensured that every barcode reading was followed by a period of system dormancy of about 2 s within which no new reading could occur. This was planned to reduce the risk that a simple movement such as taking the hand out of the container and putting it back straight afterwards would be counted as a new response.

2.5 Technology System - Functioning

A session always started with the research assistants accompanying the participants to the first desk with the objects for the first activity. As soon as the participants moved their right hand into the container with the objects to be collected (e.g., bottles or dishes) and the barcode reader read the barcode on the container, the system recorded a response and presented 3 or 4 s of preferred music. The participants were expected to place the object collected in the correct position on the left side of the desk (e.g., to place a bottle in the bottle crates or a dish in the dish drainer) (see Figure 2). Moving the right hand into the container a second time led the barcode reader to read the barcode available there once again and the system to record a second response and present a new 3- or 4-s period of preferred stimulation.

Click to view original image

Figure 2 Schematic representations of two desks with the material for two activities (i.e., placing bottles in bottle crates and placing dishes in a dish drainer). Specifically, representation A shows a container with bottles that the participants were to collect and place in bottle crates. Representation B shows a container with dishes that the participants were to collect and place in a dish drainer.

The process continued in the same way until the number of barcode readings (i.e., number of responses recorded) equaled the number programmed (i.e., the number of objects available for the activity). If the participants failed to produce a response for 15 s, the system presented verbal encouragements to continue with the activity (to use the objects) through the mini speaker available on the desk where the activity was carried out or at the participant's shoulder (Hudson). The verbal encouragements would be repeated at 10-s intervals until a new response occurred independently or with research assistants' help (see the Intervention section).

After 6-8 s from the last response (i.e., the response signaling the completion of the activity), the system activated the mini speaker on the next desk of the series containing the material for the next activity. The speaker presented verbal encouragements to reach the desk. Those encouragements (e.g., the name of the participants followed by words such as “Over here” or “Come here”) also served as spatial/orientation cues. The only exception to this was represented by Hudson who had problems orienting to sound. For him, the procedure involved the presentation of verbal encouragements to go to the next desk/activity from the mini speaker he had at his shoulder. Based on the encouragements, he was to move to the next desk following a rope that bridged the gap between the desks. The encouragements continued until the participants reached the container with objects of the next desk (i.e., until the container's barcode was read by their barcode reader) independently or with research assistants' help (see the Intervention section). The conditions for each of the activities available in the session were as those described above.

2.6 Data Recording

Data recording concerned (a) the number of objects used for the activities, (b) the number of desks reached without research assistants' help, (c) the number of objects used with system's encouragements, (d) the instances of research assistants' help (i.e., the instances in which the research assistants intervened to ensure object use or transition between desks), and (e) the length of the sessions. Research assistants recorded the data. A reliability observer was involved in data recording over at least 23% of the sessions of each participant. The percentage of agreement (computed by dividing the number of sessions in which the research assistants and the reliability observer reported the same scores on each of the first four measures and times differing less than 2 min for the last measure by the total number of sessions in which the reliability observer was involved and multiplying by 100%) was above 90% for all participants.

2.7 Experimental Conditions and Data Analysis

The study was carried out according to a nonconcurrent multiple baseline design across participants [34,35]. The participants started with a baseline phase (without the technology system). During this phase, they received different numbers of sessions (in line with the design requirements). Subsequently, an intervention phase with the technology system took place. To ensure that the research assistants would implement the baseline and intervention conditions accurately (i.e., with a high level of procedural fidelity [36]), four practice sessions were implemented before the start of the study and regular feedback was delivered during the study. The practice sessions served to ensure that the research assistants could implement baseline and intervention conditions accurately. Feedback, which was provided by a study supervisor, served to reassure the research assistants about their accurate performance and rapidly correct any inaccuracies (with the latter being virtually absent thus confirming the dependability of the research assistants).

The participants' data concerning the objects used, the desks reached without research assistants' help, and the objects used with system's encouragements were reported in graphic form. To determine the impact of the intervention on the first two measures, common nonoverlap assessment methods were used, that is, the “Percentage of Nonoverlapping Data” (PND) and the “Nonoverlap of All Pairs” (NAP) methods [37,38].

2.8 Baseline

The baseline phase included 5-10 sessions. At the start of a session, the research assistants guided the participants through the eight or nine desks with activity material available (see the Setting, Activity Material, Sessions, Research Assistants, and Music Stimulation section). Then, the research assistants accompanied the participants to the first desk and verbally encouraged them to carry out the activity. The research assistants would then record the number of objects the participants used during that activity and the following ones, and whether they reached other desks independently. For Hudson, a rope was used to bridge the gap between the desks (see the Technology System - Functioning section). The latter measure was recorded when the participants reached one of the desks available (i.e., not reached before) and searched for the objects displayed there. Research assistants' help (verbal and physical guidance) occurred if the participants (a) failed to move to a new desk/activity after a period of about 45 s had elapsed from the completion of the previous activity or from the last use of an object, and (b) did not reach the next desk within 1 min. A session ended when the participants had reached (independently or with research assistants' help) all the desks available. The total numbers of objects available for the eight or nine activities varied between 75 and 126 based on participants' activity skills.

2.9 Intervention

The intervention phase included 48-65 sessions (with differences due to participants' availability). During the intervention sessions, the participants were provided with the technology system that worked as described in the Technology System - Functioning section. At the start of a session, the participants were accompanied to the first desk and encouraged to carry out the activity available, as in baseline. Every time they took an object for the activity from a container with reproductions of a specific barcode (see Figure 1), the system recorded a response and delivered 3 or 4 s of preferred music. Failure to take any object for 15 s led the system to deliver verbal encouragements (see Figure 3), which were repeated at intervals of 10 s if the participants did not respond. Research assistants' help would be used if an interval of 45 s elapsed with no responding.

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Figure 3 The flow chart summarizes the intervention conditions.

When the number of responses (recorded by the system) corresponded to the number of objects available for the activity, the participants received encouragements to reach the next desk/activity (see the Technology System - Functioning section and Figure 3). If the participants failed to reach the next desk within 1 min, the research assistants provided help. The intervention phase was preceded by 3-5 introductory sessions during which the participants were familiarized with the response encouragements, stimulation, and encouragements to reach the desks presented by the technology system. Research assistants' help was provided to facilitate the familiarization process. The total numbers of objects available for the eight or nine activities used in the sessions ranged from 75 to 126 as in baseline.

2.10 Ethical Approval

The study was approved by the Ethics Committee of the Lega del Filo D'Oro, Osimo (AN), Italy. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

3. Results

The panels of Figure 4 summarize the baseline and intervention data of the six participants. The black triangles and empty diamonds represent the mean percentage of objects used (out of the total available for the activities) and the mean percentage of desks reached independent of research assistants' help over blocks of two sessions, respectively. The percentage of desks reached independently was computed over eight desks (from the second to the ninth) for Rowan and seven desks (from the second to the eighth) for the other participants, given that participants were regularly accompanied to the first desk. The asterisks represent the mean percentage of objects used with system's encouragements over blocks of two intervention sessions (i.e., sessions in which the system was available). Occasional blocks including three sessions (at the end of the baseline and intervention phases) are marked with an arrow. The graphs do not include the introductory sessions.

Click to view original image

Figure 4 The black triangles and empty diamonds represent the mean percentage of objects used (out of the total available for the activities) and the mean percentage of desks reached independent of research assistants' help over blocks of two sessions, respectively. The asterisks represent the mean percentage of objects used with system's encouragements over blocks of two intervention sessions.

During the baseline, the mean percentage of objects used per session ranged from about 33 (Travis) to about 71 (Luke). It may be noted that the percentage values of the last two or three sessions of the phase never exceeded the highest values recorded within the phase. The mean percentage of desks reached independent of research assistants' help was zero for all participants except Rowan whose mean percentage per session was 42.5 (with no increasing trend). The mean session duration ranged from about 17 min (Rowan) to about 29 min (Jacob).

During the intervention phase, the mean percentage of objects used per session ranged between about 97 (Avery) and nearly 100% (Luke and Jacob). Sessions with lower percentages occurred particularly at the beginning of the phase. The lower percentages typically indicate that some of the objects available for the activities were skipped by the participants. Object skipping was mainly due to the fact that (a) the participants' object searching could include behaviors such as withdrawing their hand from the container and moving it back again, (b) these behaviors could be counted by the system as new responses even when no objects had been taken, and consequently (c) the system could consider the activity completed and call the participants to the next desk before all objects had been used. Research assistants' help for lack of responding (object use) exceeding 45 s ranged from sporadic (Avery) to virtually absent (Luke and Jacob).

The mean percentage of objects used per session with system's encouragements varied from about 3.5 (Hudson) to about 10 (Avery). Some of the encouragements occurred not because the participants had a break of performance, but because the time for completing the responses was relatively long.

The mean percentage of desks reached per session independent of research assistants' help ranged from about 98 (Travis) to virtually 100 (Rowan). It may be noted that nearly all the help instances were concentrated within the initial 10 intervention sessions. The mean session duration ranged from about 16 min (Hudson) to about 27 min (Jacob).

The PND and the NAP methods produced indices of 1 for every participant on each measure, as there was no overlap between the baseline and the Intervention session values. These indices, which suggest a strong impact of the intervention, are supported by the level and immediacy of the change occurring from baseline to intervention. Such change, which remained stable across the intervention, could hardly be attributed to the 3-5 introductory sessions preceding the intervention.

4. Discussion

4.1 Main Points

The results suggest that the six participants with intellectual disability and blindness benefited from the technology system used in the study and typically managed to carry out sequences of activities and to transition between them independent of research assistants' help. These results confirm and extend previous findings on the possibility of using technology-aided programs to help people with intellectual disability and blindness perform sequences of activities independently [25,30]. In light of the above, a few considerations may be relevant.

First, people like the participants of this study can hardly be expected to engage in activity for prolonged periods of time independent of staff supervision. Daily contexts are generally short of staff resources and thus cannot guarantee prolonged periods of staff supervision with the consequence that these people tend to remain largely passive and sedentary. Technology support may be viewed as one of the few options (if not the only one) to change the situation in a constructive manner with positive implications for the participants' general occupation and possibly their quality of life [23,24,39,40].

Second, given the people's inability to manage complex activities or activities involving the use of large numbers of objects, a strategy to help them remain busy for relevant periods of time may involve the arrangement of sequences of activities for them to perform. Arranging sequences of simple activities may be functional, as shown in this study, if technology is available to help the participants (a) transition from one activity to the next in an orderly manner and so (b) manage to carry out all the activities of the sequence [15,25,26,30,41].

Third, the transition between activities may be planned to occur at preset time intervals (as it was done in previous studies [25,30]) or based on participants' performance (as it was done in the present study). The latter solution is certainly advantageous because it takes into account the fact that there may be variability in the participants' response speed across activities and sessions [12,42,43]. Using the latter solution, in practice, helps one to increase the chances that the participants are called to perform the next activity in the sequence after they have completed the previous one. To achieve this objective, the technology system used in this study monitored and counted the participants' responses through a barcode reader that the participants wore at their wrist and specific barcode reproductions fixed to the containers with the activity material.

Fourth, besides monitoring/counting the participants' responses (i.e., the objects they collected) and regulating the transition between activities, the technology system delivered preferred stimulation for the responses and verbal encouragements in relation to nonresponding periods. No specific data are available to determine whether these features were essential for the positive outcome of the intervention. Even so, one may argue that (a) the preferred stimulation contributed to make the sessions more enjoyable and increase the participants' motivation to use the objects and complete the activities, and (b) the encouragements helped in redirecting the participants' attention to the activity and thus in minimizing the need for research assistants' help [44,45].

Fifth, the technology system's components (i.e., smartphone, barcodes, barcode reader, mini speakers, and MacroDroid application) are easily accessible and affordable. The special application used in this study is freely available (https://osf.io/mfw7t/?view_only=ed094a48b4584c37ba8f2a55f3452c6f). The availability and affordability of the system components could be viewed as a favorable condition that may facilitate the adoption of the system beyond research contexts [46,47,48]. Obviously, more advanced and sophisticated technology systems might also be envisaged for future studies in line with new developments in technology areas such as artificial intelligence and human-machine interfaces [28,49,50,51].

4.2 Limitations and Future Research

The main limitations of the study are the lack of maintenance and generalization data, the lack of assessment of participants' satisfaction with the intervention sessions, and the lack of a social validation of the system and the intervention conditions. With regard to the first limitation, it may be noted that the informal opinion of staff familiar with the study was that the participants would maintain their performance and generalize it across activities and settings if they continued to receive motivating stimulation during the sessions and the new activities and contexts were comparable to those used during the intervention [44,45,52]. Future studies should (a) extend the data collection over longer periods of time, (b) replicate the intervention with various groups of participants, (c) assess its impact across activities and real-life contexts such as homes and community settings and (d) evaluate its long-term sustainability across settings [44,45,52,53,54].

With regard to the second limitation, two points can be made, that is, (a) the participants' successful performance across all intervention sessions may be taken to indicate that they were motivated to do so (and plausibly comfortable within those sessions), and (b) future studies should include formal assessment of participants' satisfaction. One way to carry out such an assessment could consist of recording the participants' indices of happiness and signs of anxiety during the sessions and other daily occupations [55,56].

To address the third limitation, new studies may need to survey staff and other rehabilitation personnel and gather their opinion about the system and the intervention conditions [57,58,59,60]. Initially, these personnel could be presented with videos of intervention sessions providing them with a picture of how the system and the intervention worked. Thereafter, they could be asked to score the system and intervention conditions in terms of effectiveness, friendliness, and usability [57,61].

The small number of participants might be viewed as a fourth limitation of the study [62,63]. With regard to this point, the two possible comments are that (a) the single-subject research design used in the study is adequate to ensure the internal validity of the data reported, and (b) replication studies could be used to determine the external validity of such data [64,65,66].

5. Conclusions

The findings suggest that the technology system helped participants with severe intellectual disability and blindness carry out sequences of activities and remain constructively engaged for practically relevant periods of time. These findings are encouraging as to the possibility of improving the situation of people with a complex intellectual and sensory condition without particular burdens on staff time. Any general statement about the findings and their implications, however, would have to be delayed until new research has amended the limitations of this study and provided confirmatory evidence. New research might also explore ways of upgrading the technology system to make it more easily applicable across people and settings.

Author Contributions

GL was responsible for setting up the study and the technology system, acquiring and analyzing the data, and writing the manuscript. GA and CF collaborated in setting up the study and the technology system, in analyzing the data, and in editing the manuscript. NS, MO'R, and JS collaborated in setting up the study, analyzing the data, and editing the manuscript.

Funding

This research received no external funding.

Competing Interests

No conflicts of interest exist. The special application used in the study is freely available at (https://osf.io/mfw7t/?view_only=ed094a48b4584c37ba8f2a55f3452c6f).

Data Availability Statement

The original data contributions presented in the study are reproduced in the graphs included in the article. Datasets are available from the authors on request.

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