Abstract
A withdrawal design study evaluated the effectiveness of using constant time delay to teach six adults with a developmental disability to program and use an iPod touch® as an electronic photographic activity schedule (ePAS). The ePAS, created with the First Then Visual Schedule app, consisted of photographs of different exercises to complete during their workout time at the recreation facility on their community college campus. Dependent variables included the percent of correct steps programming the device and the percent of exercises completed correctly. All participants learned to program their iPod touch® within six sessions and maintained the skill during the second intervention condition. For generalization, participants programmed self-selected exercises into the device and performed each exercise.
The U.S. Department of Health and Human Services (2008) recommends 150 min of moderate intensity aerobatic activity each week along with 2 or more days a week of muscle-strengthening activities. It is evident that individuals with a developmental disability (DD) can successfully participate in peer-guided (Halle, Gabler-Halle, & Chung, 1999; Stanish & Temple, 2012; Vashdi, Hutzler, & Roth, 2008) and structured exercise programs (e.g., Davis, Zhang, & Hodson, 2011; Fragala-Pinkham, Haley, Rabin, & Kharasch, 2005; Yilmaz, Ergun, Heper, Knoukman, & Zorba, 2003). In spite of these programs, physical activity declines from adolescences to adulthood for individuals with and without disabilities (Frey, Stanish, & Temple, 2008; Gordon-Larsen, Nelson, & Popkin, 2004; Kozub, 2003). The ability to self-manage exercises is needed when peers or programs have to cancel or are not available.
Self-managing daily tasks is an important life skill for all adults. Having these skills are particularly useful in leading an independent life; adults who can manage tasks are more likely to complete those tasks and reach their goals (Copeland & Hughes, 2002). Students with disabilities often need instruction to develop self-management skills (Wood, Fowler, Uphold, & Test, 2005). Students with intellectual disabilities have been taught to self-monitor their behavior (Gilberts, Agran, Hughes, & Wehmeyer, 2001), attention to a task (Kapadia & Fantuzzo, 1988), task completion (Lagomarcino & Rusch, 1989), and transitions between tasks (Carson, Gast, & Ayres, 2008; Cihak, 2011).
Previous research has shown students can use visual supports to increase task engagement, understand verbal directions, and complete a series of steps in a task. For example, picture prompts helped students complete a variety of vocational tasks such as cleaning tasks (Bates, Cuvo, Miner, & Korbeck, 2001; Copeland & Hughes, 2000; Steed & Lutzker, 1997), laundry tasks (Bates et al., 2001), packaging tasks (Johnson & Miltenberger, 1996), and daily living tasks (Pierce & Schreibman, 1994; Singh, Oswald, Ellis, & Singh, 1995). Copeland and Hughes (2000) not only taught students to use picture prompts to clean tables and sweep the floor, but they also incorporated self-monitoring strategies to initiate the task and to indicate task completion. In Steed and Lutzker (1997), one participant noted as having a profound intellectual disability not only increased the percentage of task completion and maintained the skills after the introduction of picture prompts, but she generalized the use of picture prompts to different vocational tasks.
Picture activity schedules (PAS) use a series of picture prompts to guide a student through, engage in, and complete multiple tasks or activities. Research has shown students are able to use paper-based PAS to remain on-task (Bryan & Gast, 2000; Hall, McClannahan, & Krantz, 1995; Spriggs, Gast, & Ayres, 2007), initiate and complete tasks (Bambara & Ager, 1992; Duttlinger, Ayres, Bevill-Davis, & Douglas, 2013; Irvine, Singer, Erickson, & Stahlberg, 1992), and transition between tasks (Carson et al., 2008; Martin, Elias-Burger, & Mithaug, 1987). Electronic PAS (ePAS), which provide picture prompts on an electronic device (e.g., iPod touch®, smartphone, tablet computer), have also been shown effective (Cihak, 2011; Cihak, Kessler, & Alberto, 2008; Douglas & Uphold, 2014). As society embraces self-management technology, our efforts to assist students with self-managing tasks should include these technology tools. Electronic devices have enabled people to carry their to-do lists with them in an organized and less intrusive fashion. Specifically, many self-management apps allow the inclusion of photos, audio, and video supports, which assist individuals with disabilities in managing their own tasks.
All but two of these previous studies (i.e., Douglas & Uphold, 2014; Duttlinger et al., 2013) had the teacher or another adult create the PAS or ePAS for the student. If students are to be independent, they need to create their own PAS. Duttlinger et al. (2013) replicated the Spriggs et al. (2007) study by having students create their own PAS. The teacher told the students what activities to complete and the students had to put pictures of each task on their PAS before completing all tasks. All four students increased the percentage of activities completed independently while using the PAS they created. This skill also generalized to activities in a food court at a local mall.
In addition to the need for more research on self-scheduling, the majority of PAS and ePAS research has been conducted in the classroom, home, or vocational setting (Koyama & Wang, 2011). For example, Cihak et al. (2008) evaluated the use of ePAS on a handheld computer on the transitions between vocational tasks with individuals with moderate intellectual disabilities. Independent transition was defined as completing the first task, moving to the work area of the second task, and completing the first step of the next task. All students increased their independent transitions with the use of the ePAS.
Therefore, the purpose of this study was to determine whether adults with a DD could program and use an ePAS on an iPod touch® to complete a series of exercises in a recreational facility. This study systematically replicated Douglas and Uphold (2014) with exercises as the tasks in a postsecondary environment. The specific research questions included the following: (a) Will adults with a DD learn to program an ePAS on an iPod touch® using constant time delay? (b) What effect will the self-created ePAS have on the completion of multiple exercises for adults with a DD? and (c) After instruction and skill acquisition, will the skill generalize to the adults self-scheduling exercises of their own choice?
Method
Participants
Six adults (two females and four males) with a DD attending a community college in the Midwest participated in the study (see Table 1 for participant descriptive characteristics). Their hybrid postsecondary educational program consisted of both inclusive and non-inclusive courses further developing their academic, vocational, and daily living skills. Completion of the 3-year program resulted in a certificate of achievement from the college.
Participant Descriptive Characteristics.
Note. ID = intellectual disabilities.
Wechsler was not completed. Kauffman brief composite score was a 58.
Initially, individuals in the postsecondary program volunteered to participate in the study. They were later selected by having availability in their daily schedule and demonstrating the following skills: (a) visual ability to see the icons and images on an iPod touch®; (b) motor skills necessary to physically operate the device; (d) ability to independently complete all exercises without supervision; (e) ability to count to 20; and (f) ability to attend to the task for 15 min. In addition, all but one participant had prior experience using their own iPod touch® or smartphone.
Settings and Arrangements
All participants independently arrived at the recreational facility on the community college campus. Participants swiped their student identification card and gathered needed equipment from the weight and workout rooms before coming to the exercise/stretching area adjacent to the indoor track. This area (15’ × 75’) was covered with exercise mats and provided plenty of room for the researchers (authors) to work one-on-one with the participants during each session of the study. We remained in view of the participants as they independently completed their exercises. Participants took a break (i.e., got a drink of water, went to the restroom, rested) while waiting for their turn to work with a researcher. As this was a public facility, other people were working out in the same area as the participants in the study.
Materials
Electronic device
Each participant used an iPod touch® fourth generation (16 GB) with the camera and photos applications (apps) already on the device when purchased. We downloaded the First Then Visual Schedule app from iTunes for the participants to create an ePAS.
Exercises
We identified 14 exercises that each participant could perform on their own without a support person and with few pieces of equipment (see the list of exercises and equipment in Table 2). These exercises were selected because they covered a variety of muscle groups (i.e., arms, legs, and torso) and could also be performed at home if desired. Only 6 of the 14 exercises required equipment that included a yoga ball, jump rope, and 5 lb weights. Each session incorporated 4 to 6 exercises semi-randomly selected from the bank of 14 exercises so no exercise was performed in back-to-back sessions. Participants had a limited time frame to participate in the study so only four to six exercises were chosen and the number was consistent for each session across all participants. At least one exercise related to arm muscles and one exercise related to leg muscles were included in each session. Together, these factors helped to control for list memorization.
List of Exercises and Equipment.
Dependent Measures and Response Definitions
Two dependent measures assessed the effectiveness of using constant time delay to teach the participants to program and use their iPod touch® with photos of exercises. First, the percentage of exercises completed independently was the dependent variable during all sessions. If a participant initiated the exercise within 3 s of the task direction or completion of the prior exercise and correctly completed the exercise within 1 to 5 min depending on the exercise (e.g., jumping rope takes no more than 1 min whereas walking 2 laps on the track takes up to 5 min), a correct response was recorded. If a participant completed the exercise incorrectly, did not do the correct number of repetitions, did not complete the exercise in the allotted time, or did not respond, an incorrect response was recorded. In addition, exercises had to be completed in the correct sequence or it was scored as incorrect. Although the order may not have been important for this study, teaching the participants to follow one exercise after the next was imperative for generalization to other tasks in the future in which the order does matter. If a participant did not respond or stalled in responding for 3 s, we told the participant to “Do the best you can.” If the participant stopped after another 3 s, then the session was terminated.
The second dependent variable collected only during intervention and generalization sessions was the percentage of steps completed independently and accurately when programming that day’s exercises into the iPod touch® (see Table 3 for the task analysis). A correct response involved the participant completing the step independently and accurately within 3 s of the task directions or completion of the prior step. An incorrect response included the participant performing the step incorrectly or performing the step after the deliverance of the controlling prompt (i.e., gestural prompt). A gesture prompt consisted of a point toward the icon that was to be tapped on the iPod touch®. No responses were scored as incorrect.
Task Analysis for Programming an Exercise List on the iPod touch®.
Experimental Design
To evaluate the effectiveness of the ePAS intervention, we used a single-subject withdrawal design (A-B-A-B; Gast, 2010). The three experimental conditions included no ePAS baseline probes, ePAS intervention, and generalization probes with the participant selecting his or her own exercises to program in the iPod touch®. First, baseline probes without the ePAS took place until the participant demonstrated a stable level and trend in responding (i.e., 80% of the data falling within a 20% range of the median with at least three data points). Next, ePAS intervention sessions occurred until the participant met the criteria of at least 90% correct steps programming the device for three consecutive sessions. Then the iPod touch® was withdrawn to return to baseline conditions for three sessions before returning to the ePAS intervention condition. Finally, three posttest generalization sessions occurred with the participant selecting the exercises to program into the device.
This withdrawal design study demonstrated experimental control through the increase in correct responding during intervention sessions and a decrease in correct responding during baseline sessions. A visual analysis of the data illustrated this change in level across conditions. Repeating the experimental effect with the same participant in the second baseline and intervention sessions showed direct intrasubject replication whereas replicating the study across six participants illustrated direct intersubject replication.
General Procedures
The participants learned to take photographs using the camera app on their iPod touch® before starting the study. We modeled how to use the camera by aiming it toward the desired object, holding the device still, and pressing the button to take the photo. After the participants practiced taking photos of objects not used in the study and could take three photos independently, they took photos of each other engaging in the 14 exercises used in the study. All of these pictures were automatically stored in the Photos app so they could later be used during intervention. When the participants had their picture taken completing the exercises, this also served as a pre-test to ensure that the participants knew the vocabulary and actions for each exercise. If a participant did not know an exercise, we modeled the exercise and then allowed the participant to practice.
During all sessions of the study excluding generalization, we semi-randomly selected the exercises from a bank of 14 exercises for each participant to complete (i.e., exercises could not be selected in back-to-back sessions). The number of exercises each session (i.e., 4–6) was randomly selected. Four to six exercises were chosen due to time constraints of the participants. At the beginning of each session and after gaining the participant’s attention by saying his or her name and establishing eye contact, verbal directives were provided for the four to six exercises that the participant needed to complete.
At least three baseline probes without the iPod touch® were conducted before the participant learned how to program his or her electronic device with a picture list of the exercises using constant time delay. During intervention, the first session had a 0 s delay and then all subsequent sessions incorporated a 3 s delay. A gesture prompt (e.g., the researcher pointing to the + symbol on the iPod touch®) was the controlling prompt. After the instructional criterion was met, the iPod touch® was removed to return to baseline conditions. After three baseline sessions, the iPod touch® was reintroduced for three sessions. Finally participants programmed their device with exercises of their choice during three generalization sessions. Each session ended with the researcher providing praise for a good job exercising. Sessions lasted no more than 15 min and occurred 2 days a week with no more than two sessions per day, separated by at least 30 min.
No ePAS baseline sessions
After gaining the participant’s attention, we provided the task directions, “Today’s exercises are (named 4–6 exercises). Let me know when you are finished with your exercises.” The iPod touch® was not available during baseline sessions. Participants had to complete the exercises based on what they heard and remembered. We said “Do the best you can” if a participant did not respond or stalled in responding for 3 s. The session ended if the participant was not responding after another 3 s. When the participant finished completing tasks, we delivered general reinforcing praise such as “good job exercising today.” No other reinforcement was provided during the session. Exercises were scored as correct, incorrect, or no response. Baseline sessions occurred until at least three data points were stable with 80% of the data falling within a 20% range of the median or there was a decelerating trend. Participants moved on to the intervention condition once their individual baseline data stabilized.
ePAS intervention sessions
Constant time delay was the systematic instructional procedure used to teach the participants how to program their iPod touch® with a picture list of exercises. One 0 s delay session started the intervention condition and then all subsequent sessions included a 3 s delay. The controlling prompt for all intervention sessions was a gesture prompt.
Once we gained the participant’s attention by calling his or her name and making eye contact, we taught the steps for programming the iPod touch®. We provided the verbal directives “Today’s exercises are ______” and assigned Exercise #1. During the 0 s delay session, we immediately prompted the participant with a gesture after the task direction or completion of the previous step, allowing the participant to see and experience all steps of the task analysis without making an error. The participant completed Steps 1 to 14 on the task analysis found in Table 3 in this manner. After Step 14, we assigned Exercise #2. Steps 6 to 14 were repeated until all 4 to 6 exercises were assigned and listed on the ePAS. We scored each step of the task analysis as correct, incorrect, or no response. If a step was completed independently without any prompting, then the step was scored correct. If prompting was provided, then the step was scored incorrect. Once the participant developed his or her ePAS, he or she could go and complete the exercises. We said, “Let me know when you are finished with your exercises.” The participant then looked at the photograph of the exercise on his or her iPod touch® and completed it. After finishing the exercise, the participant picked up his or her device and swiped his or her finger across the screen to see the next exercise. This process continued until all of the exercises were completed and the participant said he or she was finished. The scoring of the completion of these exercises was done in the same manner as baseline.
During the 3 s delay sessions, we stated the task direction, assigned Exercise #1, and then waited 3 s for the participant to initiate Step 1 on the task analysis. When the participant completed the step correctly without any prompting, we scored that step as correct and waited 3 s for the participant to initiate Step 2. In instances where the participant did not respond to the task direction or initiated an incorrect response, we provided a gestural controlling prompt. In this case, for the first step the researcher pointed to the home button on the device. This least intrusive controlling prompt provided just enough support for each participant to exhibit a correct response. The step was scored as incorrect whenever the participant needed a prompt to complete the step. This process of waiting 3 s for the participant to respond continued until all exercises were programmed in the app. We then told the participant to let us know when he or she was finished and scored the completion of the exercises. The criteria to move to the next condition consisted of the participant demonstrating 90% correct responses over three consecutive sessions.
Generalization sessions
After two alternating baseline and two intervention conditions, three generalization sessions evaluated the participants’ ability to develop their own list of exercises. These sessions were conducted in a similar fashion as the baseline sessions. No specific prompting or feedback was provided; however, the iPod touch® was available and the task direction delivered by the researcher changed to “Today you get to pick your exercises. Let me know when you are finished with your exercises.” Non-contingent verbal praise was provided at the end of the session regardless of correct or incorrect responding. We scored each exercise as correct, incorrect, or no response, and collected data on the percentage of steps completed independently when programming the iPad.
Reliability
We collected interobserver and procedural reliability data on each other during at least 30% of the sessions for each participant with at least one session per condition being evaluated. Interobserver reliability included data on both dependent measures (i.e., correctness of exercise completion and steps for programming the device). We used the point-by-point method of dividing the number of researcher and observer agreements by the number of agreements plus disagreements and multiplying by 100 to calculate interobserver reliability (Tawney & Gast, 1984). Procedural reliability evaluated the consistency of the researchers’ engagement in the following behaviors: (a) stating participant’s name to get his or her attention; (b) making eye contact with the participant; (c) saying “Today’s exercises are (list 4–6 exercises)”; (d) saying “Let me know when you are finished with your exercises”; (e) recording participant responses; (f) giving verbal praise at the end of each session; (g) saying “Do the best you can” if participant does not respond or stalled for 3 s; and (h) standing in view of the participant at all times. We calculated procedural reliability by dividing the number of observed researcher behaviors by the number of opportunities to exhibit the behaviors and multiplying by 100 (Billingsley, White, & Munson, 1980).
Social Validity
After the participants completed the study, we collected social validity data in the form of an interview with each individual separately. Each participant verbally answered questions on the purpose and outcomes of the study.
Results
Reliability
Interobserver and procedural reliability data were collected on 30% of each participant’s sessions. Both interobserver and procedural reliability data were 100%.
Effectiveness of Intervention
Delia
During both baseline phases, Delia had a low percentage of exercises performed correctly. Delia had a change in level during both ePAS intervention phases. The absolute change in level was 47 points. The data showed 100% non-overlapping data between ePAS1 and No ePAS1 and No ePAS1 and ePAS2. Delia learned to program the device in five sessions, including one session at 0 s time delay and three consecutive sessions at 90% correct responding. During generalization, Delia programmed the device for her chosen exercises and then completed these exercises with 100% accuracy. See Figure 1 for her data.
Data for Delia, Ware, and Jaxon with closed diamonds representing percentage of tasks completed correctly and open circles representing the percentage of correct steps independently programming the device.
Ware
During No ePAS1, Ware did not complete any exercises correctly and during No ePAS2 he did not complete more than 40% of the exercise correctly (see Figure 1). Ware had a change in level during both ePAS intervention phases. The absolute change in level was 60 points. The data demonstrated 100% non-overlapping data between ePAS1 and No ePAS1 and No ePAS1 and ePAS2. Ware also learned to program the device in five sessions. Ware generalized programming the device to his own chosen exercises with 100% accuracy and completed 100% of these exercises correctly across three sessions.
Jaxon
During No ePAS1, Jaxon did not complete any exercises correctly and did not complete more than 60% of the exercises correctly during No ePAS2 (see Figure 1). Jaxon had a change in level during both ePAS1 and ePAS2 intervention phases. The absolute change in level was 15 points and data showed 87.5% non-overlapping data between ePAS1 and No ePAS1 and No ePAS1 and ePAS2. Jaxon learned to program the device in five sessions. Due to scheduling difficulties, Jaxon only had two generalization sessions. Jaxon programmed his own exercises with 98% and 100% accuracy, and performed these exercises with 100% accuracy.
Caden
Caden had a low percentage of exercises performed correctly in both No ePAS1 and No ePAS2 (see Figure 2). Caden had a change in level during both ePAS intervention phases. The absolute change in level was 47 points. The data demonstrated 100% non-overlapping data between ePAS1 and No ePAS1 and No ePAS1 and ePAS2. Caden learned to program the device in four sessions. Due to scheduling difficulties, Caden only had two generalization sessions. Caden generalized programming the device to his own chosen exercises with 100% correct responses and performed these exercises with 100% accuracy.
Data for Caden, Carson, and Macy with closed diamonds representing percentage of tasks completed correctly and open circles representing the percentage of correct steps independently programming the device.
Carson
During No ePAS1, Carson completed 60%, 0%, and 17% of his exercises correctly (see Figure 2). During ePAS1, Carson completed between 33% and 100% of his exercises correctly. During no ePAS2, Carson had a low percentage of exercises completely correctly; however, during ePAS2, he completed 100% of his exercises correctly. Carson had difficulty swiping to the next picture; he would scroll through all of the pictures instead of just scrolling to the next picture and he often lost his place in the list of exercises. The data demonstrated 88.9% non-overlapping data between ePAS1 and No ePAS1 and No ePAS1 and ePAS2. Carson learned to program the device in six sessions. Carson generalized programming the device to his own chosen exercises with 100%, 98%, and 100% correct responses, and performed these exercises with 100% accuracy across all three sessions.
Macy
During both baseline conditions, Macy had a low level of exercises performed correctly (see Figure 2). Macy had a change in level during both ePAS intervention phases. The absolute change in level was 50 points. The data demonstrated 100% non-overlapping data points between ePAS1 and No ePAS1 and No ePAS1 and ePAS2. Macy learned to program the device in four sessions. Macy generalized programming the device to her own self-selected exercises with at least 83% accuracy and performed these exercises with 100% accuracy.
Social Validity
All participants stated they liked using the iPod touch®. Two participants said using the iPod touch® was easy, one stated it was hard, and three stated it was both easy and hard to use. In addition, all participants stated they used the iPod touch® to complete exercises with two individuals specifically mentioning that it helped them complete tasks in a certain order and two others stating it helped them remember how many of each exercise to complete.
Each participant stated they liked completing the recreation tasks. One individual stated “(it) makes you feel energized for the rest of the day.” Four of the six participants stated they did these exercises outside of the research time. When asked about other possible settings or ways to use the iPod touch®, participants stated other exercise facilities, at home, when applying for a job, and while making dinner.
Discussion
Research has shown that individuals with a DD can effectively use visual supports to increase task engagement, understand verbal directions, and complete a series of tasks. Furthermore, when individuals with a DD solve their own problems and use self-management strategies, such as using visual supports to regulate their behavior, they will require fewer external supports, which lead to greater independence and ultimately enhance their quality of life.
Previous research on PAS has centered on adult created or directed paper-based schedules (Bambara & Ager, 1992; Bryan & Gast, 2000; Carson et al., 2008; Hall et al., 1995; Irvine et al., 1992; Martin et al., 1987; Spriggs et al., 2007), whereas this study evaluated whether individuals could independently program and self-create their own schedules using an iPod touch®. The results from this study showed that individuals could independently program the electronic device and select their own exercises, which supports previous researchers who believed that individuals will become more independent if taught to create their own schedule (Douglas & Uphold, 2014; Duttlinger et al., 2013).
Although there are benefits to a paper-based schedule such as being inexpensive, easily replaceable, and customizable, the advantages of using technology cannot be overlooked. The social and educational implications of technology are growing, as technology is considered to increase one’s productivity, efficiency, and independence. Its effectiveness for individuals with disabilities is no exception as technology is less stigmatizing, age-appropriate, and easy to use. All participants in this study learned to program the device within six instructional sessions.
There are several discussion points resulting from the data. Both Jaxon and Carson decreased the number of correct responses immediately following the 0 s delay session. Jaxon did not complete the correct number of exercises (e.g., he only completed 6 arm presses, rather than the required 10.) Carson had two errors, completing the wrong exercises and completing the exercises in the wrong order. Both participants continued this error for another session, before returning to 100% correct responding. It is possible both participants were focused on programming the device correctly, rather than on performing the exercises correctly. As they became more comfortable with programming the iPod, the participants were able to also focus on the exercises.
All participants generalized their programming skills to their own choice of exercises. It is interesting to note that all participants picked a wide variety of exercises that involved all muscle groups. Except for one individual (i.e., Macy), all participants choose no more than one exercise from the previous generalization session. In addition, Ware and Jaxon always choose five exercises to complete, Caden choose six exercises, and Delia choose four exercises. Macy was the only student who chose a different number of exercises and repetitions than were required in the ePAS conditions. For example, Macy chose to jump rope 100 times as compared with the required 10 times during intervention. Participants became comfortable completing a wide variety of exercises during the invention phases and choose to maintain this pace during generalization.
Limitations and Future Research
Although this study does hold promise that adults with a DD can program and use an ePAS to complete a series of exercises in a recreational facility, there continues to be need for additional research, specifically to address potential limitations. One limitation to the study is the size of the sample. To validate the use of ePAS for scheduling and completing a series of recreational activities, future studies should include a larger sample size.
A second limitation to the study was that research with all participants occurred within the same recreational facility. This may have (a) unintentionally aided in individual progress, as participants may have learned and modeled what other participants were doing, and (b) the setting may have limited the opportunities to generalize the skills. Future research should include investigating whether individuals can program and use an ePAS in a variety of settings where recreational activities may occur, including the home, without the potential for outside influences. Also, future research should include the use of workout machines or equipment that other people may want to use at the same time. It is common for several individuals to want to use the same machine or equipment at the same time. This requires some problem-solving skills to determine how the machine can be shared among individuals.
Because the primary purpose of the study was to determine whether the participant could use and program the electronic device, the researchers did not include the participants completing multiple repetitions of the exercises. However, if the participants had performed multiple sets, they may have completed a full workout. It is therefore recommended that future studies require participants to complete an entire workout session. By completing a full workout, participants will gain a true understanding of the skills and time needed to complete a typical workout and work toward meeting the recommended activity level for a week.
During their workout, participants moved from one exercise to the next with little to no transition time (less than 1 min) between each exercise. In addition, each exercise lasted an average of 1 min before the participant moved to the next exercise. It is safe to assume that individuals may participate in exercises that last longer than a few minutes. Moreover, once the individual uses these skills in the natural setting without researcher presence, it is reasonable to believe he or she will be faced with distractions. With this in mind, future research should include an increase in the time between tasks as well as exercises that last longer to see whether the participant remembers to go back to the device to check the next exercise without prompting.
Social validity findings were collected through interviews from the adults who participated in the investigation. Participants were asked whether they liked the exercises and whether they could see using the iPod touch® for other tasks or activities. To determine social appropriateness and acceptance, it may be beneficial to gain social validation data from employees or same age members at the recreation facility to verify the usefulness of the exercises and practical application of the iPod touch®.
As previously mentioned, it is believed that all individuals benefit from the use of iPod touches® or other electronic devices to assist with and regulate self-management tasks. For the purpose of this study, an inexpensive app (First Then Visual Schedule) was used. In the future, researchers might consider investigating a variety of scheduling apps used by same age peers that have been specifically developed to support recreation workouts and that contain a variety of user options.
Implications for Practice
This study, combined with the previous studies, showed strong evidence that individuals with disabilities can learn to create an ePAS and self-manage a series of tasks. By self-managing tasks, individuals can become more independent in their environments and decrease their reliance on adult support. This is becoming more important as funding for services is decreasing. Adult supports are just not available for many individuals with disabilities so any materials or technology that can provide support should be developed and taught. Adult life brings the need to manage daily life tasks, whether at home, on the job, or in the community. Adults with disabilities need the skills and supports to manage these tasks without assistance from others.
As we think about teaching individuals to manage the completion of multiple tasks, younger students should be taught to self-manage a series of known tasks first, as this is easier than learning and self-managing the task at the same time. As students get older and they expand the number of tasks they self-manage, they can learn to self-manage their tasks in a variety of settings, such as academic classes, job sites, and recreation facilities. Teachers can provide support in school to teach self-management skills of classroom tasks or across content areas. Once students master this skill, ideally they will transfer this to vocational and other community settings. Also, as students gain more experience, they can be taught how to create their own schedules. Independence is key as students prepare to transition out of school. The goal is for students to master self-management skills while they are in school and have supports available to them so when they transition out of school and lose those supports, they can create their own ePAS to manage their daily tasks.
As technology is so readily available and less intrusive and stigmatizing than paper, ePAS should be used to self-manage tasks. Younger students may benefit from using a tablet computer at first due to fine motor skills and having larger pictures. As students get older, they can use smartphones and iPods, although tablets may be best for some individuals due to eye sight or fine motor skills. Ideally, students will select their preferred device to self-manage different tasks (Douglas & Uphold, 2014).
In conclusion, self-management skills are important for promoting independence in all areas of life including recreation. Research has shown that people of all ages and abilities can improve their quality of life with exercise; however, participation in physical activities dramatically decreases from adolescence to adult life as structured classes and programs are no longer available. For individuals with disabilities, the likelihood that they will continue with these activities will be greater if they are given the strategies and skills, such as using an ePAS, needed to self-manage exercises and physical activities.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.