Technology-aided programs to enable persons with multiple disabilities to choose among environmental stimuli using a smile or a tongue response.
A smile or tongue can become a fast, cheap switch for clients who cannot move anything else.
01Research in Context
What this study did
Two adults with severe motor impairments tried three microswitch setups. One switch watched for a smile. One watched for a tongue poke. One watched for a head or chin lift.
Each switch let the user pick music, lights, or a fan. The team counted how often the switch worked on the first try.
What they found
Smile and tongue switches worked almost every time. Head or chin switches rarely worked.
Both adults learned to use the smile or tongue switch in minutes and kept using it across days.
How this fits with other research
Robertson et al. (2013) ran a nearly identical study the same year and got the same result: smile switches work for people with almost no movement.
Ivancic et al. (1996) warned that some clients never respond even to high-preference items. The 2013 papers show that giving a very small, reliable response like a smile can fix that problem.
Anonymous (2025) later swapped the microswitch for a modified touch screen and still saw near-perfect choice making. The goal—easy access—stays the same while the tools keep improving.
Why it matters
If a client can smile or stick out a tongue, you can give them a voice today. Tape a cheap optic sensor to a glasses frame, link it to a tablet, and let them pick songs, call Mom, or turn on a fan. Start with one simple choice and one clear switch. Once it works, add more items. No extra staff, no big budget—just a smile.
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02At a glance
03Original abstract
Persons with multiple disabilities, including pervasive motor impairment, may have problems controlling even small responses (e.g., vocal emissions, finger movements, or prolonged eyelid closures) within time-sensitive situations, such as those involved in choice programs. Recent research has indicated that smile expressions can be used as functional choice responses for some of these persons. The present two studies were aimed at assessing the smile response for a child with congenital multiple disabilities and a tongue response for a post-coma man who had recovered his consciousness but presented with pervasive multiple disabilities. The first of the two studies represented a research extension (i.e., a new case with a slightly adapted microswitch technology) concerning the smile response, which had recently been evaluated with few other cases. The second study represented a new effort to assess the tongue response within a choice program and for a post-coma man with multiple disabilities. The results showed that the participants used the smile and the tongue responses successfully while they were apparently unsuccessful in using a slight head/chin movement response. Their choice behavior focused reliably on preferred stimuli and avoided non-preferred stimuli. Implications of the results are discussed.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.09.003