title: Challenges of developing communicative interaction in individuals with congenital profound intellectual and multiple disabilities.
abstract: BACKGROUND
  Physiological responses have been used in individuals with acquired disability to enable communicative interaction without motor movement. This study explored four autonomic nervous system (ANS) signals-electrodermal activity, skin temperature, cardiac patterns and respiratory patterns-to enable interaction with individuals born with profound intellectual and multiple disabilities (PIMD).
  
  
  METHODS
  A series of case studies were conducted to teach a 15-year-old individual with PIMD to voluntarily control his ANS signals for the purposes of communicative interaction. Training was carried out according to an alternating treatment single-subject research design.
  
  
  RESULTS
  Training was unsuccessful; however, ANS signal patterns revealed issues unique to people with PIMD: profound intrasubject variability, discrepancy between physiological responses and caregiver perspectives, and the participant's lack of contingency awareness.
  
  
  CONCLUSIONS
  These three priority areas unique to people with congenital PIMD must be addressed before ANS signals can be used to enable communicative interaction with this population.
authors.affiliation: Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI 48109-5841, USA. sblain@umich.edu
authors.forename: Stefanie
authors.initials: S
authors.lastname: Blain-Moraes
authors.forename: Tom
authors.initials: T
authors.lastname: Chau
mesh_terms: D000015:Abnormalities, Multiple / Q000534:rehabilitation*; D000293:Adolescent; D001341:Autonomic Nervous System / Q000502:physiology*; D003142:Communication; D000013:Congenital Abnormalities / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000534:rehabilitation; D006321:Heart / Q000502:physiology; D006801:Humans; D008607:Intellectual Disability / Q000534:rehabilitation*; D007398:Interpersonal Relations; D008297:Male; D056152:Respiratory Rate / Q000502:physiology; D012720:Severity of Illness Index; D012867:Skin