Alertness in individuals with profound intellectual and multiple disabilities: a literature review.
No reliable alertness tool exists for clients with profound ID, so your data may be noise.
01Research in Context
What this study did
The authors read every paper they could find on alertness in people with profound intellectual and multiple disabilities. They wanted to know how staff measure if someone is awake, calm, and ready to learn.
Most studies used informal notes or checklists that were never tested for accuracy. No two teams defined alertness the same way.
What they found
There is no trusted tool to score alertness in this group. Without a common yardstick, study results cannot be compared.
Direct support staff are left guessing, so data quality is weak across the board.
How this fits with other research
Delprato (2002) found the same hole in risk-assessment tools for offenders with ID. Both reviews end with the same call: build new, validated instruments.
Enkelaar et al. (2012) show balance and gait deficits are well documented in ID, yet alertness gaps remain hidden. Together these papers signal that motor and arousal data are both shaky.
Meuret et al. (2001) prove microswitches can give a voice to clients with profound disabilities. If alertness had a similar clear metric, staff could know exactly when to offer those switches.
Why it matters
You cannot teach, medicate, or exercise someone who is drowsy or overstimulated. A five-item alertness checklist that any DSP can complete in thirty seconds would let you start sessions at the right moment, track response to meds, and show families real data. Push your team to define alertness in observable terms—eyes open, head up, vocal or motor response in three seconds—and trial one shared sheet across shifts.
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02At a glance
03Original abstract
Direct support persons (DSPs) often face problems in observing and determining alertness in individuals with profound intellectual and multiple disabilities (PIMD). A literature study was carried out to gather information about the problems just described. A search of two electronic databases and the references found in relevant hits revealed 42 relevant publications. The results show that two types of descriptions of alertness can be distinguished: (1) those with a focus on the individual only or (2) those with a focus on the interaction of individual and environment. Several observation categories were used in the studies that were found. The reliability of the observations turned out to be a core problem in most of the studies. Only a limited number of environmental conditions that were expected to have an impact on alertness in individuals with PIMD were investigated. While modifications of the environment, interaction strategies, stimulation strategies and staff training were found to have a positive impact on alertness, studies about treatment activities led to conflicting results. Finally, we will formulate the resulting implications for future studies and for the development of an instrument for DSPs in order to observe alertness in individuals with PIMD in clinical practice.
Research in developmental disabilities, 2009 · doi:10.1016/j.ridd.2008.07.003