Promoting Occupational Engagement and Personal Satisfaction in People with Neurodevelopmental Disorders via a Smartphone-Based Intervention

  • Giulio E. LancioniEmail author
  • Mark F. O’Reilly
  • Jeff Sigafoos
  • Gloria Alberti
  • Francesca Campodonico
  • Valeria Chiariello



This study assessed a smartphone-based program to foster basic occupational engagement and personal satisfaction, and eventually increase physical exertion (heart rates), in people with extensive neurodevelopmental disorders.


The program relied on a Samsung Galaxy A3 smartphone with Android 6.0 operating system, near-field communication function, and MacroDroid application. Seven participants were involved. The participants’ occupational responses consisted of putting special (hard and thick) cards into an elevated box (into contact with the smartphone) by stretching their arm. The responses activated the smartphone, which delivered brief periods of preferred stimulation. Failure to produce responses led the smartphone to deliver a verbal prompt/encouragement to respond.


All participants had significant increases (p < 0.01) in occupational responses and heart rates, and six of them also showed a significant increase in the level of personal satisfaction, during program sessions as opposed to baseline or control sessions. The Kolmogorov–Smirnov test and paired t test were used to assess the changes across sessions.


A simple smartphone-based program might be suitable to support occupational engagement, increase heart rates, and foster personal satisfaction in people with extensive neurodevelopmental disorders.


Smartphone-based program Neurodevelopmental disorders Occupational engagement Heart rates Personal satisfaction 


Authors’ Contributions

GL was responsible for setting up the study, acquiring and analyzing the data, and writing the manuscript. MO, JS, GA, FC, and VC collaborated in setting up the study and/or analyzing the data and writing/editing the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Ethical Approval

Approval for the study was obtained from the Ethics Committee of the Lega F. D’Oro, Osimo, 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.

Informed Consent

Written informed consent for the participants’ involvement in the study was obtained from their legal representatives.


  1. Balboni, G., Belacchi, C., Bonichini, S., & Coscarelli, A. (2016). Vineland II. Vineland Adaptive Behavior Scales (2nd ed.). Firenze: Standardizzazione Italiana: OS.Google Scholar
  2. Baris, V. K., & Seren Intepeler, S. (2018). Journal of Clinical Nursing. Views of key stakeholders on the causes of patient falls and prevention interventions: A qualitative study using the international classification of functioning, disability and health.
  3. Barlow, D. H., Nock, M., & Hersen, M. (2009). Single-case experimental designs (3rd ed.). New York: Allyn & Bacon.Google Scholar
  4. Bartlo, P., & Klein, P. J. (2011). Physical activity benefits and needs in adults with intellectual disabilities: Systematic review of the literature. American Journal on Intellectual and Developmental Disabilities, 116, 220–232.CrossRefGoogle Scholar
  5. Blain-Moraes, S., & Chau, T. (2012). Challenges of developing communicative interaction in individuals with congenital profound intellectual and multiple disabilities. Journal of Intellectual and Developmental Disability, 37, 348–359.CrossRefGoogle Scholar
  6. Brandt, M. J., Ijzerman, H., Dijksterhuis, A., Farach, F. J., Geller, J., Giner-Sorolla, R., et al. (2014). The replication recipe: What makes for a convincing replication? Journal of Experimental Social Psychology, 50, 217–224.CrossRefGoogle Scholar
  7. Brown, I., Hatton, C., & Emerson, E. (2013). Quality of life indicators for individuals with intellectual disabilities: Extending current practice. Intellectual and Developmental Disabilities, 51, 316–332.CrossRefGoogle Scholar
  8. Camden, C., Shikako-Thomas, K., Nguyen, T., Graham, E., Thomas, A., Sprung, J., et al. (2015). Engaging stakeholders in rehabilitation research: A scoping review of strategies used in partnerships and evaluation of impacts. Disability and Rehabilitation, 37, 1390–1400.Google Scholar
  9. Channon, A. (2014). Intellectual disability and activity engagement: Exploring the literature from an occupational perspective. Journal of Occupational Science, 21, 443–458.CrossRefGoogle Scholar
  10. Copeland, S. R., Luckasson, R., & Shauger, R. (2014). Eliciting perceptions of satisfaction with services and supports from persons with intellectual disability and developmental disabilities: A review of the literature. Journal of Intellectual Disability Research, 58, 1141–1156.Google Scholar
  11. Davies, D. K., Stock, S. E., Herold, R. G., & Wehmeyer, M. L. (2018). GeoTalk: A GPS-enabled portable speech output device for people with intellectual disability. Advances in Neurodevelopmental Disorders, 2, 253–261.CrossRefGoogle Scholar
  12. Dillon, C. M., & Carr, J. E. (2007). Assessing indices of happiness and unhappiness in individuals with developmental disabilities: A review. Behavioral Interventions, 22, 229–244.CrossRefGoogle Scholar
  13. Dickson, C. A., McDonald, R. P., Mansfield, R., & Ahearn, W. H. (2014). Social validation of the New England center for children-core skills assessment. Journal of Autism and Developmental Disorders, 44, 65–74.CrossRefGoogle Scholar
  14. Fernhall, B., McCubbib, J. A., Pitetti, K. H., Rintala, P., Rimmer, J. H., Millar, A. L., et al. (2001). Prediction of maximal heart rate in individuals with mental retardation. Medicine and Science in Sports and Exercise, 33, 1655–1660.CrossRefGoogle Scholar
  15. Gellish, R. L., Goslin, B. R., Olson, R. E., McDonald, A., Russi, G. D., & Moudgil, V. K. (2007). Longitudinal modeling of the relationship between age and maximal heart rate. Medicine and Science in Sports and Exercise, 39, 822–829.CrossRefGoogle Scholar
  16. Green, C. W., & Reid, D. H. (1999). A behavioral approach to identifying sources of happiness and unhappiness among individuals with profound multiple disabilities. Behavior Modification, 23, 280–293.CrossRefGoogle Scholar
  17. Hagopian, L. P., Long, E. S., & Rush, K. S. (2004). Preference assessment procedures for individuals with developmental disabilities. Behavior Modification, 28, 668–677.CrossRefGoogle Scholar
  18. Hill, K., Gardiner, P. A., Cavalheri, V., Jenkins, S. C., & Healy, G. N. (2015). Physical activity and sedentary behaviour: Applying lessons to chronic obstructive pulmonary disease. Internal Medicine Journal, 45, 474–482.CrossRefGoogle Scholar
  19. Hinckson, E. A., & Curtis, A. (2013). Measuring physical activity in children and youth living with intellectual disabilities: A systematic review. Research in Developmental Disabilities, 34, 72–86.CrossRefGoogle Scholar
  20. Janssen, I., & LeBlanc, A. G. (2010). Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International Journal of Behavioral Nutrition and Physical Activity, 11, 40. Scholar
  21. Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). New York: Oxford University Press.Google Scholar
  22. Ketelaar, M., Vermeer, A., Hart, H., Van Petegem-van Beek, E., & Helders, P. J. M. (2001). Effects of a functional therapy program on motor abilities of children with cerebral palsy. Physical Therapy, 81, 1534–1545.CrossRefGoogle Scholar
  23. Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Green, V. A., Oliva, D., Campodonico, F., et al. (2013). Technology-aided programs to support exercise of adaptive head responses or leg-foot and hands responses in children with multiple disabilities. Developmental Neurorehabilitation, 16, 237–244.CrossRefGoogle Scholar
  24. Lancioni, G., O’Reilly, M., Singh, N., Sigafoos, J., Boccasini, A., La Martire, M. L., et al. (2016). Technology to support positive occupational engagement and communication in persons with multiple disabilities. International Journal on Disabilities and Human Development, 15, 111–116.Google Scholar
  25. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Alberti, G., Perilli, V., et al. (2017a). Promoting functional activity engagement in people with multiple disabilities through the use of microswitch-aided programs. Frontiers in Public Health, 5, 205. Scholar
  26. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Boccasini, A., Perilli, V., et al. (2017b). Persons with multiple disabilities manage positive leisure and communication engagement through a technology-aided program. International Journal of Developmental Disabilities, 63, 148–157.CrossRefGoogle Scholar
  27. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Alberti, G., Campodonico, F., et al. (2018a). Non-ambulatory people with intellectual disabilities practice functional arm, leg or head responses via a smartphone-based program. Journal of Developmental and Physical Disabilities.
  28. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Alberti, G., Perilli, V., et al. (2018b). An upgraded smartphone-based program for leisure and communication of people with intellectual and other disabilities. Frontiers in Public Health, 6, 234. Scholar
  29. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Alberti, G., Perilli, V., et al. (2018c). A tablet-based program to enable people with intellectual and other disabilities to access leisure activities and video calls. Disability and Rehabilitation: Assistive Technology.
  30. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Campodonico, F., Oliva, D., et al. (2018d). Using microswitch-aided programs for people with multiple disabilities to promote stimulation control and mild physical exercise. Journal of Intellectual and Developmental Disability, 43, 242–250.CrossRefGoogle Scholar
  31. Lenker, J. A., Harris, F., Taugher, M., & Smith, R. O. (2013). Consumer perspectives on assistive technology outcomes. Disability and Rehabilitation: Assistive Technology, 8, 373–380.Google Scholar
  32. Leopold, A., Lourie, A., Petras, H., & Elis, E. (2015). The use of assistive technology for cognition to support the performance of daily activities for individuals with cognitive disabilities due to traumatic brain injury: The current state of research. NeuroRehabilitation, 37, 359–378.CrossRefGoogle Scholar
  33. Lin, Y. H., Chen, C. Y., & Cho, M. H. (2012). Effectiveness of leg movement in reducing leg swelling and discomfort in lower extremities. Applied Ergonomics, 43, 1033–1037.CrossRefGoogle Scholar
  34. Luiselli, J. K., Bass, J. D., & Whitcomb, S. A. (2010). Teaching applied behavior analysis knowledge competencies to direct-care service providers: Outcome assessment and social validation of a training program. Behavior Modification, 34, 403–414.CrossRefGoogle Scholar
  35. Makel, M. C., & Plucker, J. A. (2014). Facts are more important than novelty: Replication in the education sciences. Educational Researcher, 43, 304–316.CrossRefGoogle Scholar
  36. McDougall, J., Evans, J., & Baldwin, P. (2010). The importance of self-determination to perceived quality of life for youth and young adults with chronic conditions and disabilities. Remedial and Special Education, 31, 252–260.Google Scholar
  37. Munde, V., & Vlaskamp, C. (2015). Initiation of activities and alertness in individuals with profound intellectual and multiple disabilities. Journal of Intellectual Disability Research, 59, 284–292.CrossRefGoogle Scholar
  38. Peacock, J. L., & Peacock, P. J. (2010). Oxford handbook of medical statistics. London: Oxford University Press.CrossRefGoogle Scholar
  39. Pierce, W. D., & Cheney, C. D. (2008). Behavior analysis and learning (4th ed.). New York: Psychology Press.Google Scholar
  40. Raspa, M., Fitzgerald, T., Furberg, R. D., Wylie, A., Moultrie, R., DeRamus, M., et al. (2018). Mobile technology use and skills among individuals with fragile X syndrome: Implications for healthcare decision making. Journal of Intellectual Disability Research, 62, 821–832.CrossRefGoogle Scholar
  41. Segibaeva, M. O., Pogodin, M. A., Lavrova, I. N., Balykin, M. V., & Aleksandrova, N. P. (2011). Effect of head-down tilt on respiratory responses and human inspiratory muscle activity. Human Physiology, 37, 171–177.CrossRefGoogle Scholar
  42. Shih, C.-H., Chang, M.-L., & Shih, C.-T. (2010). 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.CrossRefGoogle Scholar
  43. Shih, C. T., Shih, C. H., & Luo, C. H. (2013). Assisting people with disabilities in actively performing physical activities by controlling the preferred environmental stimulation with a gyration air mouse. Research in Developmental Disabilities, 34, 4328–4333.CrossRefGoogle Scholar
  44. Shooshtari, S., Temple, B., Waldman, C., Abraham, S., Ouellette-Kuntz, H., & Lennox, N. (2017). Stakeholders’ perspectives towards the use of the comprehensive health assessment program (CHAP) for adults with intellectual disabilities in Manitoba. Journal of Applied Research in Intellectual Disabilities, 30, 672–683.CrossRefGoogle Scholar
  45. Siegel, S., & Castellan, N. J. (1988). Nonparametric statistics (2nd ed.). New York: McGraw-Hill.Google Scholar
  46. Sparrow, S., Cicchetti, D., & Balla, D. (2005). Vineland-II adaptive behavior scales (2nd ed.). Minneapolis: Pearson.Google Scholar
  47. Stasolla, F., Perilli, V., Di Leone, A., Damiani, R., Albano, V., Stella, A., et al. (2015). Technological aids to support choice strategies by three girls with Rett syndrome. Research in Developmental Disabilities, 36, 36–44.CrossRefGoogle Scholar
  48. Sunderland, N., Catalano, T., & Kendall, E. (2009). Missing discourses: Concepts of joy and happiness in disability. Disability and Society, 24, 703–714.CrossRefGoogle Scholar
  49. Taylor, M. J., Taylor, D., Gamboa, P., Vlaev, I., & Darzi, A. (2016). Using motion-sensor games to encourage physical activity for adults with intellectual disability. Studies in Health Technology and Informatics, 220, 417–423.Google Scholar
  50. Verdugo, M. A., Navas, P., Gomez, L. E., & Schalock, R. L. (2012). The concept of quality of life and its role in enhancing human rights in the field of intellectual disability. Journal of Intellectual Disability Research, 56, 1036–1045.CrossRefGoogle Scholar
  51. Waninge, A., Van der Putten, A. A. J., Stewart, R. E., Stenbergen, B., van Wijck, R., & van der Schans, C. P. (2013). Heart rate and physical activity patterns in persons with profound intellectual and multiple disabilities. Journal of Strength and Conditioning Research, 27, 3150–3158.CrossRefGoogle Scholar
  52. Wen, C. P., Wai, J. P. M., Tsai, M. K., Yang, Y. C., Cheng, T. Y., Lee, M. C., et al. (2011). Minimum amount of physical activity for reduced mortality and extended life expectancy: A prospective cohort study. The Lancet, 378, 1244–1253.CrossRefGoogle Scholar
  53. Whiting, M. (2014). Children with disability and complex health needs: The impact on family life. Nursing Children and Young People, 26, 26–30.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Giulio E. Lancioni
    • 1
    Email author
  • Mark F. O’Reilly
    • 2
  • Jeff Sigafoos
    • 3
  • Gloria Alberti
    • 4
  • Francesca Campodonico
    • 4
  • Valeria Chiariello
    • 4
  1. 1.Department of Neuroscience and Sense OrgansUniversity of BariBariItaly
  2. 2.University of Texas at AustinAustinUSA
  3. 3.Victoria University of WellingtonWellingtonNew Zealand
  4. 4.Lega F. Doro Research CenterOsimoItaly

Personalised recommendations