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Article

Supporting Functional Occupation of People with Moderate Intellectual Disability and Blindness Using a Smartphone-Based Technology System

by
Gloria Alberti
1,
Giulio E. Lancioni
1,*,
Nirbhay N. Singh
2,
Mark F. O’Reilly
3 and
Jeff Sigafoos
4
1
Lega F. D’Oro Research Center, 60027 Osimo, Italy
2
College of Medicine, Augusta University, Augusta, GA 30912, USA
3
Department of Special Education, University of Texas at Austin, Austin, TX 78712, USA
4
School of Education, Victoria University of Wellington, Wellington 6012, New Zealand
*
Author to whom correspondence should be addressed.
Disabilities 2025, 5(4), 96; https://doi.org/10.3390/disabilities5040096
Submission received: 14 July 2025 / Revised: 22 September 2025 / Accepted: 20 October 2025 / Published: 22 October 2025
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Abstract

People with intellectual disability and visual impairment often have difficulties in accessing leisure events, engaging in cognitive activities, and performing physical exercise. The present study assessed a program aimed at helping six adults with moderate or moderate-to-mild intellectual disability and blindness in each of the aforementioned areas. The program relied on the use of a technology system involving a smartphone, which was supplied with Internet connection and fitted with the Live Transcribe and MacroDroid applications. These applications were set up to (a) enable the participants to use verbal utterances to successfully access preferred songs and comic sketches (leisure events) and answer series of verbal questions (cognitive activity) automatically presented to them, and (b) enable the smartphone to verbally guide the participants’ performance of series of body movements (physical exercise). The program was introduced according to a nonconcurrent multiple baseline design across participants. The intervention was divided into two phases, which included 17–33 and 39–48 sessions, respectively. The results showed that the participants’ baseline performance (without the support of the system) was generally poor. During the intervention with the system, all participants succeeded in accessing the music or comic events available, satisfactorily answering series of questions, and performing series of body movements. The Percentage of Nonoverlapping Data and the Tau (novlap) methods used to compare baseline and intervention performance produced indices of 1 for all participants (confirming the strong impact of the intervention). These results, which need replication to establish their generality, suggest that the technology system might represent a useful tool for helping people like the participants of this study.

1. Introduction

People with intellectual disability and people with combinations of intellectual disability and blindness (i.e., people for whom limited literature attention and treatment resources seem to be available [1,2,3,4]) can have difficulties in several areas of their daily life. For example, they may have difficulties completing multistep tasks due to the inability to remember and perform all the task steps [5,6,7]. They may have difficulties accessing preferred leisure events such as music because of their insufficient skills in operating standard music playing devices and selecting their preferred music through those devices [8,9,10,11]. They may have difficulties engaging in forms of cognitive exercise (e.g., answering questions/riddles concerning common/basic topics) because they tend to be fairly passive and isolated and thus do not have many opportunities to access these forms of activity [11,12,13,14]. They may also have difficulties practicing useful/beneficial body movements concerning arms, legs or head and neck because they lack initiative (self-determination) and motivation to engage in physical exercise [15,16,17,18].
Staff supervision to help people overcome these difficulties may be one of the options available. However, its application can be quite costly in terms of staff time and may not be effective in promoting independence [7,8,9,10]. An alternative to the use of staff supervision is apparently represented by intervention programs supported by assistive technology. Several practically relevant technology-assisted programs have been developed over the years to enable people to reach forms of constructive and functional engagement independent of staff [19,20,21,22,23,24]. For example, programs have been developed and successfully assessed to help people carry out multistep tasks [5,6,25,26,27], perform physical exercise [28,29,30,31,32], or make comprehensible verbal requests for preferred events [33,34,35,36,37,38].
More recently, programs have also been developed to extend people’s level of constructive occupation through the combination of different forms of activity. These programs, which provided promising results, are considered important to promote variation in people’s engagement and create the basis for prolonged and satisfactory occupation independent of staff. The activities combined (interspersed) within the programs could include leisure and communication [39], leisure, communication, and simple pre-vocational tasks [40], or leisure, communication, and cognitive exercise [11]. In this last study [11], two programs were set up and each of them was assessed with two participants. The program set up for the first two participants, who presented with moderate intellectual disability and blindness, involved a smartphone connected via Bluetooth to a commercial two-switch device. The smartphone was fitted with a SIM card and the WhatsApp and MacroDroid applications. At the start of a session, the smartphone verbally informed the participants that they could listen to music by pressing the first switch or send a message to a partner by pressing the second switch. If the participants chose the music option, the smartphone verbalized at intervals of 2–4 s the names of four different singers. As the participants chose a singer (i.e., by pressing the first switch), the smartphone played a song of that singer. If the participants chose the message option, the smartphone verbalized the names of five partners. As the participants chose a partner (by pressing the second switch), the system prepared to send the voice message that the participants provided (spoke). Once the song was over or the message was sent, the smartphone informed the participants that they could make another choice between music and messages, and all conditions were as described above.
Thereafter, the smartphone presented a 2–4 min story on a topic of interest to the participants. At the end of the story, the smartphone presented a series of questions concerning the story. For each question, the smartphone suggested two possible answers. If the participants selected the correct answer, the smartphone said “OK, Correct” and moved to present the next question. If the participants selected the wrong answer, the smartphone did not provide any feedback and paused until the correct answer occurred. A session alternated four choice periods with three stories, each of which was followed by a series of questions. The results were highly positive, with both participants learning to use the system and accessing music, sending messages, and listening to stories and answering story-related questions independent of external assistance.
The program set up for the other two participants, who presented with moderate or mild intellectual disability, functional residual vision, and motor impairments, involved the use of a tablet interfaced with two separate pressure sensors. The difference in this program from the one described above was that the participants could make video calls (instead of using voice messages) and watch music videos (instead of simply listening to songs). The results obtained with the second program were highly positive, comparable with those described for the first program.
The practical relevance of supporting people’s engagement in different types of activities without need for staff supervision and the positive results obtained with the programs described above represent strong motivations for advancing the research in this area. New research efforts could be aimed at setting up programs that would combine (a) access to preferred leisure (enjoyable) events with (b) forms of cognitive activity and physical exercise, that is, forms of engagement that are considered important for vitalizing basic intellectual and physical functions of people who tend to be withdrawn and passive (i.e., people who would be unable to access any of the aforementioned engagement options without some support). The inclusion of preferred leisure events in the programs was thought to be critically important not only to provide the participants with enjoyment occasions but also to motivate them to engage in presumably non-preferred (less preferred) cognitive and physical exercise [9,11].
The present study was aimed at setting up one such program and assessing its impact with six participants with intellectual disability and blindness. The program relied on the use of a smartphone, which was supplied with Internet connection and fitted with the Live Transcribe and MacroDroid applications. Live Transcribe is a free application that provides real-time transcriptions of spoken words into text. It is available on the Google Play Store or already installed on the smartphone and only needs to be enabled under the accessibility settings. MacroDroid is an application to automate tasks on Android devices and is available on the Google Play store. These two applications were chosen because they were considered suitable for the study, readily accessible, and easy to use. Each session included (a) preferred songs or comic sketches (leisure options), (b) series of verbal questions concerning areas of relevance and interest to the participants such as geography, recent history, food, and sport (cognitive activity), and (c) a variety of simple body movements such as arms and head movements, which had been recommended by physiotherapists (physical exercise). The program’s impact was assessed using single-case research methodology. The hypothesis was that the program would be effective in helping the participants manage the different occupation options and reach practically relevant periods of constructive engagement independent of staff.

2. Methods

2.1. Participants

Table 1 lists the six participants with the pseudonyms of Sam, Jasper, Melody, Logan, Vivian, and Eden and reports their chronological ages and their Vineland age equivalents obtained by using the second edition of the Vineland Adaptive Behavior Scales [41,42]. All participants had a diagnosis of congenital encephalopathy with intellectual disability and blindness. Vivian and Logan also presented with motor impairments that prevented ambulation or made it possible only with some support. Their chronological age ranged from 31 to 66 years. Their Vineland age equivalents varied between 2 years and 1 month and 4 years and 6 months for Daily Living Skills (personal sub-domain), 5 years and 1 month and 7 years and 1 month for receptive communication, and 3 years and 11 months and 6 years and 2 months for expressive communication. No recent IQ scores were available for them. The rehabilitation and care centers that they attended had rated their level of functioning to be in the moderate intellectual disability range. The only possible exception was Vivian, for whom the rating of moderate-to-mild intellectual disability range was also reported.
The participants represented a convenience sample in that they were recruited from rehabilitation and care centers belonging to the same Italian organization [43]. Their selection was based on a number of criteria, which had been verified through preliminary observations or staff interviews. First, they tended to be sedentary and isolated when no staff support was available. Second, they were considered to have the language prerequisites to succeed in activating the technology system used in this study to make their leisure choices and answer the questions presented to them during the study sessions. Third, the program was considered to be enjoyable and beneficial for them. In fact, they were known to like leisure events such as music and comic sketches and these events were thought to motivate their involvement in the sessions. Their cognitive (memory) functions were expected to be stimulated by the series of questions that they were asked to answer during the sessions. The body movements programmed within the sessions represented a mild form of physical exercise useful to curb their physical idleness without being taxing. Fourth, staff personnel were highly supportive of the program and approved the technology system, which had been illustrated to them in advance.

2.2. Ethical Considerations

Prior to the beginning of the study, regular staff and research assistants (a) explained to the participants how the technology system worked and which options it presented during the sessions, and (b) asked the participants whether they would be willing to use the system. Their positive answer to the question (i.e., expressing willingness to use the system) was taken as consent to the study. However, given that there was some uncertainty as to whether they had a clear/detailed view of what the study included and given that they were unable to sign a consent form, their legal representatives were involved in the consent process (i.e., they read and signed the consent form on the participants’ behalf). The study was approved by the Ethics Committee of the Lega F. D’Oro. All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

2.3. Setting, Sessions, and Research Assistants

Quiet rooms of the rehabilitation and care centers that the participants attended served as setting for the study. The study involved baseline sessions without the system and intervention sessions with the system. Sessions were implemented by research assistants, typically once or twice a day, 5 or 6 days a week. Five research assistants, who held university psychology degrees, were employed to implement the sessions and record the data. The research assistants were experienced in working with people with disabilities, in using assistive technology, and in collecting data through different data recording methods.

2.4. Technology System (Components)

The technology system involved a smartphone operating on Android, which was supplied with Internet connection and fitted with the Live Transcribe and MacroDroid applications. The Live Transcribe application served to capture the participants’ speech from the smartphone’ microphone and display it as text on the smartphone’s screen. The MacroDroid application served to (a) read the text on the smartphone’s screen and regulate the smartphone’s responses to such text in accordance with the intervention conditions, and (b) control the presentation of the leisure options, the questions, and the physical exercise requests included in the sessions (see below). It also assisted with data recording (see the Section 2.7).

2.5. Technology System (Functioning)

Table 2 summarizes the functioning of the technology system by describing the conditions available during the four-stage sequences (i.e., leisure, cognitive activity, leisure, and physical exercise), which were arranged within the sessions. A session started with a leisure stage. The smartphone presented the participants with the names of two singers (i.e., two singers, a singer and a band or two bands) or two comedians (e.g., “Do you want Madonna or Coldplay?”). The participants could choose one of the options by repeating the name of that option (e.g., “Coldplay”). The smartphone captured the name the participants verbalized, displayed it on the screen as text and, in relation to it, presented a song by the singer/band chosen. To minimize the risk that participants’ pronunciation/utterance difficulties could cause recognition failures and thus nullify the choice, the smartphone was programmed to respond (play the option chosen) to the transcription of the correct name (e.g., Coldplay) as well as to the transcription of a list of similar words or word combinations selected by research assistants on preliminary tests of the technology with the single participants and stored in the smartphone via the MacroDroid application (e.g., “Cold”, “Play”, “Call”, “Pay”, “Coal” “Coaly”, and “Coolly”). The options (singers and comedians) presented to the participants changed within and across sessions. Changes also occurred with regard to the songs and comic sketches played in relation to the singers and comedians. Songs and sketches were played for 2 min.
Following the end of the song or comic sketch of the aforementioned leisure stage, the cognitive activity stage started. The smartphone presented a series of five or seven questions on a variety of topics (e.g., recent history, geography, cooking, animal life, and sport). For each question, the smartphone provided three possible answers. For example, the smartphone could verbalize the question: “Which is the capital of Portugal?: Madrid, Lisbon, or Dublin?”. If the participants answered “Lisbon”, the smartphone said “Good” and presented the next question. If the participants answered “Madrid” or “Dublin”, the smartphone said: “Try again” and repeated the question. As with the names of singers and comedians, the smartphone was programmed to respond to the transcription of the correct word as well as to the transcription of other (similar) words previously stored in the system via the MacroDroid application. To avoid the risk that an unrecognized answer would block the session progress, the system was programmed to move to the next question after it had received the correct answer or an interval of 20 s had elapsed without correct answer.
Once all the questions of the series had been answered, a new leisure stage started. The smartphone presented the participants with two new leisure options (e.g., two new singers or two new comedians). The participants were to choose one of the options. Conditions were as described for the first leisure stage. The end of the song or comic sketch was followed by the physical exercise stage, with the smartphone presenting a series of body movements that the participants were to perform. For example, the smartphone could request the participants to raise their arms and bring them down 10 times (i.e., repeating the instruction to do so 10 times, with a preset interval between instruction presentations). It could also add a request to bend the head to the right and then to the left for 10 additional times (again repeating the instruction at preset intervals). Physiotherapists had rated these movements as mild, safe, and appropriate forms of physical exercise.
Once the physical exercise stage was over, the smartphone reproduced the sequence described above (i.e., leisure, cognitive activity, leisure, and physical exercise) two more times. In practice, each session included three sequences, each of which involved choosing between leisure options (singers/comedians), answering a series of questions, choosing between new leisure options, and performing a series of body movements. The series of questions changed. Similarly, the physical exercise stages included new body movements or new combinations of them.

2.6. Experimental Conditions

The study was conducted according to a nonconcurrent multiple baseline design across participants [44,45]. This design was considered adequate to exclude threats to the internal validity of the data. Given the age (experience) and condition of the participants, performance improvements were thought to be unlikely to occur due to maturation or history [44,46]. Initially, there was a baseline phase in which the participants had a smartphone with Google Assistant enabled. This phase included different numbers of sessions for the different participants (i.e., as required by the design). Then, two intervention phases were implemented during which the participants were provided with the technology system described above.
Prior to the beginning of the study, the research assistants were to practice the baseline and intervention procedural conditions within simulated sessions. Practice continued until they were able to apply those conditions accurately. To ensure that they would maintain their accuracy (i.e., their procedural fidelity [47]), regular feedback was provided to them about their performance. Feedback (delivered by a study coordinator who had access to films of the sessions) was to rapidly correct possible inaccuracies, which resulted practically absent throughout the study.

2.6.1. Baseline

During the 5–10 baseline sessions, the participants sat at a desk and had a smartphone available in front of them, in which Google Assistant had been enabled (see Figure 1). At the start of a session, the research assistants explained to the participants that they could (a) listen to songs or comic sketches by saying “Hey Google play SINGER/BAND OR COMEDIAN’S NAME or SONG’S TITLE”, (b) ask for riddles to answer by saying “Hey Google tell me a riddle” (riddles represented the closest Google-mediated alternative to the smartphone’s questions used during the intervention), and (c) perform series of 10 body movements (e.g., raising the arms 10 times or touching the feet 10 times). Then, the research assistants invited the participants to start with one of those options. If the participants did not succeed for 20 s, the research assistants provided help. A 20 s interval was considered adequate for a response to occur and for limiting frustration in case of response failure. Research assistants’ help could consist of making the request for a song, which played for 2 min. At the end of the song (or of any other option irrespective of whether it had been accessed independently or with help), the research assistants invited the participants to access one of the options available. If the participants failed to respond, the research assistants provided help as above. For example, they asked the smartphone’s Google Assistant to present a series of five riddles (one at a time) for the participants to answer or verbally guided the participants into performing a series of 10 body movements. This process continued throughout the session, which lasted until the participants had accessed six songs or comic sketches, answered 15 riddles, and performed three series of 10 body movements or until four consecutive instances of research assistants’ help had occurred. In the latter case, the songs/comic sketches and riddles not accessed and the body movements not performed were rated as dependent on research assistants’ help.

2.6.2. Intervention I

During the 17–33 sessions of Intervention I, the participants were provided with the technology system that worked as described in the Section 2.4 and Section 2.5. Specifically, the session would start with the smartphone providing the participants with (a) a choice between two singers or two comedians that enabled the participants to listen to a 2 min song or comic sketch, (b) the presentation of a series of five questions that the participants were to answer, (c) a new choice between two singers/comedians, and (d) a series of 10–15 body movements that the participants were to perform (see Figure 2). A series of body movements could involve the repetition of the same movements (e.g., arms up and down) or combinations of different movements (e.g., arms up and down followed by head up and down).
The aforementioned sequence (i.e., leisure, cognitive activity, leisure, physical exercise) was replicated two more times within the session. Any sequence differed from the previous in that it involved new singers/comedians, a new series of questions, and a new series of body movements and/or a new combination of them. The phase was introduced by two to four practice sessions, in which the research assistants helped the participants familiarize themselves with the system and the responses required. No research assistants’ help was scheduled to occur during the regular intervention sessions except in the case in which the participants could not manage to have the name of a singer or comedian recognized by the system for 20 s.

2.6.3. Intervention II

During the 39–48 sessions of Intervention II, the cognitive activity and physical exercise were somewhat extended compared to Intervention I (i.e., to increase the participants’ level of constructive occupation). Specifically, the sessions of Intervention II involved series of seven (rather than five) questions and series of 15–25 (rather than 10–15) body movements.

2.7. Measures and Data Recording

All sessions were filmed. Data recording carried out directly and via films concerned (a) songs or comic sketches accessed correctly and independent of research assistants’ help, (b) riddles accessed and answered correctly during baseline using Google Assistant independent of research assistants’ help, (c) correct answers provided to the smartphone’s questions during the intervention (i.e., correct answers that occurred as first response attempt and were recognized by the smartphone), (d) body movements performed independent of research assistants’ help, that is, movements of any of the series available (during the baseline) or of the series presented by the smartphone (during the intervention), and (e) length of the sessions. During the baseline sessions, the research assistants recorded all measures except correct answers to the smartphone’s questions (not occurring during baseline). During the intervention sessions, they only recorded the body movements. The songs/sketches accessed correctly, the correct responses to the smartphone’s questions, and the length of the sessions were recorded via the technology system.
Interrater agreement was checked in all baseline sessions (for all measures except answers to the smartphone’s questions) and in more than 22% of the intervention sessions for body movements through the employment of a reliability observer. Agreement for songs/sketches accessed and riddles answered correctly was recorded when research assistants and reliability observer had the same scores. Agreement for body movements and session length was recorded when research assistants and reliability observer had scores that differed no more than three units and 2 min, respectively. The percentage of agreement over the baseline sessions (computed for the single participants by dividing the number of sessions in which agreement was reported for all measures available during that phase by the total number of sessions and multiplying by 100%) was 86–100%. The percentage of intervention sessions with agreement on body movements was above 90% for all participants.

2.8. Data Analysis

The baseline and intervention data were reported in graphic format. To determine the impact (effect size) of the intervention on the participants’ performance, the Percentage of Nonoverlapping Data (PND) and the Tau (novlap) methods [48,49,50] were applied with the following measures: songs or comic sketches accessed independently, riddles/questions answered correctly, and body movements performed.

3. Results

The panels of Figure 3 summarize the baseline and intervention data for the six participants. The black triangles represent the mean percentage of songs or comic sketches accessed independent of research assistants’ help per session over blocks of two sessions. The asterisks represent the mean percentage of riddles accessed independent of research assistants’ help and answered correctly (during baseline) and of smartphone’s questions answered correctly (during intervention) over the same blocks of sessions. The empty circles represent the mean percentage of body movements performed independent of research assistants’ help over those blocks of sessions. Occasional blocks of three sessions (i.e., at the end of the baseline and intervention phases) are marked with an arrow. The practice sessions preceding the start of Intervention I are not reported in the figure.
During the baseline phase, the mean percentage of songs/sketches accessed independently, of riddles accessed independently and answered correctly, and of body movements performed independently per session varied between 0 (Eden) and 37 (Logan), 0 (all except Vivian) and 5 (Vivian), and 0 (Sam) and 56 (Vivian), respectively. Except for Logan, the participants only sporadically (or never in the case of Eden) managed to have their utterances recognized by Google Assistant to independently access songs/sketches. Similarly, the participants (nearly) always failed to independently access and correctly answer Google-mediated riddles. With regard to the body movements, the participants tended to start and perform parts of the series available, with the exception of Sam. It may be noteworthy that the percentage values of the last two or three sessions of the phase were very low or lower than the highest values reached in the phase for all measures. The mean session length ranged from 12 to 18 min, with the sessions interrupted after four consecutive instances of research assistants’ help.
During Intervention I, the mean percentage for songs/sketches accessed per session was 100 for Melody, Logan, and Vivian, 99 for Jasper and Eden, and 97.5 for Sam. The last three participants received one instance (Jasper and Eden) or three instances (Sam) of research assistants’ help to ensure the smartphone’s recognition of singer/comedian’s names. The mean percentage for correct answers to the questions and body movements varied between 90 (Logan) and 97 (Jasper) and between 90 (Logan) and close to 100 (Melody), respectively. The mean session length varied between 23 and 27 min.
It may be noteworthy that (a) there was no overlap between the baseline session values and the Intervention I session values for any of the measures and thus the PND and the Tau (novlap) methods produced indices of 1 for every participant on each measure, (b) the change between the baseline and Intervention I was clear in terms of level and immediacy and remained stable, and (c) such change could hardly be ascribed to the two to four practice sessions preceding the start of Intervention I. All these points may be taken to suggest a strong impact of the technology system.
During Intervention II, the mean percentage for songs/sketches accessed per session was 100 with a single exception (i.e., Jasper). The mean percentage per session varied between 93 (Vivian) and 97 (Melody and Eden) for correct answers to the questions, and always exceeded 98 for body movements. The mean session length varied between 25 and 30 min. Essentially, the data of Intervention II, during which the cognitive activity and physical exercise were extended with larger numbers of questions and body movements, showed clear continuity with the data of Intervention I, confirming the impact of the technology system.

4. Discussion

4.1. Principal Findings

The results, which would need replication to establish their generality, suggest that the intervention with the technology system was effective in enabling participants with intellectual disability and blindness to independently access songs and comic sketches, to correctly answer series of questions concerning current topics, and to carry out series of body movements. These results (a) confirm previous findings in the area indicating that it is possible to devise technology-aided programs to support different types of activities for people with intellectual disability and blindness or combinations of visual and motor impairments [5,6,39], and (b) extend those findings in that the new study included a simplified form of cognitive activity as well as the performance of series of body movements (physical exercise) as intervention targets [11,39,51,52,53]. In light of these results, several considerations may be in order.
First, this study can be viewed as an additional effort aimed at developing technology-aided programs to extend people’s level of constructive occupation through the combination of different forms of activity. The three forms of activity targeted in this study were considered (a) relevant to improve the participants’ condition (i.e., by allowing access to preferred leisure events and vitalizing basic intellectual and physical functions) and (b) unlikely to be accessible within the daily context without staff supervision [15,54,55]. The extended (recurrent) availability of the leisure (pleasant) activity during the sessions was thought to be instrumental in motivating the participants to remain constructively engaged throughout the length of the intervention sessions and thus also manage to carry out both the cognitive activity and physical exercise (i.e., not necessarily preferred forms of occupation for them) [56,57].
Second, the participants’ data concerning the performance of the cognitive activity and physical exercise during the intervention phases may be taken to (a) support the assumption on participants’ motivation made above and (b) emphasize the importance of how those two forms of engagement were arranged within the sessions. With regard to the latter point, it might be argued that the feedback provided to the participants on their answers to the questions and the verbal instructions used for guiding their performance of the body movements involved in each series played a relevant role. The feedback, which was largely positive, could have worked as a mild reinforcing event that helped to increase the participants’ awareness of their answers and their motivation to engage in the activity [56,57]. The verbal instructions/requests to perform specific movements (i.e., instructions/requests that the smartphone repeated as many times as the number of movements the participants were to perform) may have been critical to help the participants complete the movement series correctly [57].
Third, the cognitive activity and physical exercise used in this study were chosen as they were considered suited and beneficial to the participants and practical to arrange within the program. Indeed, the questions covered areas rated as relevant and interesting to the participants and helped them to rehearse/consolidate their knowledge in those areas and eventually extend such knowledge [58,59]. The body movements were recommended by physiotherapists as beneficial for the participants and could be easily represented/described through verbal instructions. It might be reasonable to assume that other forms of cognitive activities (e.g., identifying missing words or specific characters in different stories) and other types of physical exercise (e.g., exercises involving the use of simple tools such as elastic bands and light weight dumbbells) could be included in the program.
Fourth, the combined use of the Live Transcribe application and the MacroDroid application could be considered critical for the positive outcome of the intervention. In fact, the Live Transcribe application was instrumental to capture the participants’ speech from the smartphone’s microphone and display it as text on the smartphone’s screen. The MacroDroid application was used to program the smartphone to respond to the text displayed on its screen (by the Live Transcribe application) both when such text represented correct words and when it corresponded to lists of similar words or word combinations, which had been selected for the single participants during preliminary tests of the technology. The availability of specific lists of words for every participant may be the main reason that explains why all participants had successful outcomes. Indeed, the use of those word lists was seemingly critical to minimize the risk that participants’ pronunciation/utterance difficulties could cause the system to fail to recognize their leisure choices or answers to the questions and thus incur procedural errors or session stoppages. Verbal recognition failures could have been frequent without those lists (as indicated by failures to access songs/sketches and riddles via Google Assistant during the baseline).
Fifth, it may be important to point out that the technology system’s components (i.e., the smartphone and the Live Transcribe and MacroDroid applications) are commercially available and easily affordable. These aspects make the technology used in the present study accessible to daily contexts interested in applying the intervention conditions described above. Notwithstanding the accessibility of the system components, it may be necessary to clarify that acquiring those components does not make the system ready for use. Indeed, one would still have to program the smartphone’s functioning through the use of the aforementioned applications. Such operation, albeit not particularly complex, requires a basic level of familiarity with technology issues. The authors would be available to provide direct help to anyone who is interested in setting up the program reported and using the same technology system.
Sixth, in view of the facts that (a) the smartphone, once programmed, does not require specific, time-consuming adjustments and (b) participants remain highly independent during the sessions, one might argue that the implementation of those sessions could be continued over time without significant staff time investment. In essence, one might speculate that the use of those sessions could remain sustainable within daily contexts, thus extending the education/rehabilitation offer of these contexts and enriching the participants’ occupational opportunities and possibly their quality of life [60,61,62,63,64].

4.2. Limitations and Future Research

While the results of the study appear quite promising, caution should be used in interpreting them as the study presented several limitations. The most obvious limitations concern the absence of maintenance and generalization data, the lack of assessment of participants’ satisfaction with the technology system and the intervention sessions, and the lack of a social validation of the technology system and its impact and applicability. To amend the first limitation, future studies would need to (a) conduct long-term follow-ups to evaluate maintenance of gains, (b) replicate the intervention with different groups of people to determine the strength of the intervention across participants, (c) test the program in real-life contexts such as homes, schools, and community settings to determine its applicability and effectiveness across those settings, and (d) evaluate its long-term sustainability within those settings [56,57,60,64,65].
With regard to the second limitation, three points can be made. First, the data show that the participants remained constructively engaged throughout the intervention sessions. These data might suggest that the participants had a good level of acceptance of (satisfaction with) the sessions and their content [56,57]. Second, anecdotal reports indicated that the participants were willing/eager to be involved in the sessions. Third, future studies would be expected to include a formal assessment of participants’ satisfaction. The assessment could involve (a) interviewing the participants as to whether they like the sessions, (b) measuring their indices of happiness/satisfaction during and outside of the sessions, and (c) having them choose between the sessions and other types of daily occupations [66,67].
To amend the third limitation, new studies could include a survey of staff and caregivers about the impact, social relevance, and usability of the technology system. The survey could be carried out by (a) providing these personnel with details of the program and the technology involved, (b) showing them video clips of the intervention sessions (i.e., of the participants using the system) and (c) asking them to provide their rating of the impact, social relevance, friendliness, and usability of the system and the program relying on it [68,69,70,71,72]. Formal scales about the usability of the system (e.g., the System Usability Scale) may also be employed [73,74].
A fourth limitation of the study concerns the relatively small number of participants. The first consideration regarding this point is that the single-case research design used in the study may be considered adequate to guarantee the internal validity of the data reported (see the Section 2.6 [44,45,75]). The second consideration is that single-case replication studies and possibly group studies will be critical to determine the external validity of those data and their generalizability and final implications [76,77,78].
An additional limitation concerns the absence of any measurement of the beneficial effects of the body movements. In this study, their beneficial effects were assumed based on the expert opinion of physiotherapists and the fact that these movements are a common practice in gym sessions. New research will have to determine the true value of those movements through the definition of specific parameters and their use to assess the participants’ condition over time [15,29].

5. Conclusions

The results suggest that the intervention conditions with the support of the technology system were effective in enabling participants with intellectual disability and blindness to independently access songs and comic sketches, answer series of questions, and carry out series of body movements. While the findings are promising, the study’s limitations suggest that further research is needed in order to confirm the reliability and generalizability of the data reported and determine their specific implications for relevant daily contexts such as homes, schools, and community settings. New research could also focus on upgrading the technology system and extending the occupational areas targeted by the intervention (e.g., including practically/vocationally relevant tasks among those areas).

Author Contributions

G.A. and G.E.L. were responsible for setting up the study and the technology system, acquiring and analyzing the data, and writing the manuscript. N.N.S., M.F.O. and J.S. collaborated in setting up the study, analyzing the data, and writing/editing the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was approved by the Ethics Committee of the Lega F. D’Oro, Osimo, Italy (P031020252, 10 March 2025). All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent Statement

The participants’ legal representatives provided written informed consent for the participants’ involvement in the study.

Data Availability Statement

The original data contributions presented in the study are reproduced in the graphs included in the article. Complete datasets are available from the authors on request.

Conflicts of Interest

The authors declare no conflicts of interest.

Disability Language/Terminology Positionality Statement

In this paper, a clear effort was made to use respectful and inclusive language in relation to people with disabilities. We chose to use person-first language following the terminology adopted in the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and other international legal documents as well as in a plurality of international scientific journals. We believe this approach is much more appropriate and respectful of the human dignity than the identity-first approach. To emphasize the individuality and humanity of the participants, we refer to them with specific male and female names in the Section 2.1 of the paper as well as in the Section 3 and in the graphs.

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Figure 1. The Flowchart Summarizes the Conditions Available during Baseline.
Figure 1. The Flowchart Summarizes the Conditions Available during Baseline.
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Figure 2. The Flowchart Summarizes the Conditions Available during Intervention I.
Figure 2. The Flowchart Summarizes the Conditions Available during Intervention I.
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Figure 3. The Black Triangles Represent the Mean Percentage of Songs or Comic Sketches Accessed Independently Per Session over Blocks of Two Sessions. The Asterisks Represent the Mean Percentage of Riddles Accessed Independently and Answered Correctly (during Baseline) and of Smartphone’s Questions Answered Correctly (during Intervention) over the Same Blocks of Sessions. The Empty Circles Represent the Mean Percentage of Body Movements Performed Independently over Those Blocks of Sessions. Occasional Blocks of Three Sessions Are Marked with An arrow.
Figure 3. The Black Triangles Represent the Mean Percentage of Songs or Comic Sketches Accessed Independently Per Session over Blocks of Two Sessions. The Asterisks Represent the Mean Percentage of Riddles Accessed Independently and Answered Correctly (during Baseline) and of Smartphone’s Questions Answered Correctly (during Intervention) over the Same Blocks of Sessions. The Empty Circles Represent the Mean Percentage of Body Movements Performed Independently over Those Blocks of Sessions. Occasional Blocks of Three Sessions Are Marked with An arrow.
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Table 1. Participants’ Chronological Age and Vineland Age Equivalents for Daily Living Skills, Personal Sub-domain (DLSP), Receptive Communication (RC) and Expressive Communication (EC).
Table 1. Participants’ Chronological Age and Vineland Age Equivalents for Daily Living Skills, Personal Sub-domain (DLSP), Receptive Communication (RC) and Expressive Communication (EC).
Participants
(Pseudonyms)		Chronological
Age (Years)		Vineland Age Equivalents 1
(Years, Months)
DLSPRCEC
Sam664, 25, 15, 0
Jasper524, 35, 64, 10
Melody313, 64, 33, 11
Logan563, 65, 14, 10
Vivian552, 17, 16, 2
Eden534, 66, 25, 5
1 Age equivalents are based on the Italian standardization of the Vineland Scales [41].
Table 2. Summary of the Technology System’s Functioning during the Four-Stage Sequences (Leisure, Cognitive Activity, Leisure, and Physical Exercise) Arranged within the Sessions.
Table 2. Summary of the Technology System’s Functioning during the Four-Stage Sequences (Leisure, Cognitive Activity, Leisure, and Physical Exercise) Arranged within the Sessions.
Four-Stage SequenceTechnology System’s Functioning
1. Leisure
  • Smartphone presented the names of two singers or two comedians.
  • Participants were to choose one of the two by repeating the related name.
  • Smartphone (1) captured the name the participants verbalized, (2) displayed such name on its screen as text, and (3) in relation to the name (or similar preselected words), presented a song or comic sketch by the singer or comedian chosen for 2 min.
2. Cognitive ActivityFollowing the end of the song or comic sketch of the aforementioned leisure stage, the smartphone presented a series of questions, with three possible answers for each of them.
  • If participants answered correctly, the smartphone verbalized “Good” and presented the next question.
  • If participants answered incorrectly, the smartphone verbalized “Try again” and repeated the question.
  • If a 20 s interval elapsed without correct answer, the smartphone proceeded to the next question.
3. LeisureFollowing the end of the questions of the cognitive activity stage, the smartphone presented the names of two singers or two comedians. Conditions were as in the first leisure stage.
4. Physical ExerciseFollowing the end of the song or comic sketch of the latter leisure stage, the smartphone presented a series of body movements that the participants were to perform and provided an instruction for each of those movements.
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Alberti, G.; Lancioni, G.E.; Singh, N.N.; O’Reilly, M.F.; Sigafoos, J. Supporting Functional Occupation of People with Moderate Intellectual Disability and Blindness Using a Smartphone-Based Technology System. Disabilities 2025, 5, 96. https://doi.org/10.3390/disabilities5040096

AMA Style

Alberti G, Lancioni GE, Singh NN, O’Reilly MF, Sigafoos J. Supporting Functional Occupation of People with Moderate Intellectual Disability and Blindness Using a Smartphone-Based Technology System. Disabilities. 2025; 5(4):96. https://doi.org/10.3390/disabilities5040096

Chicago/Turabian Style

Alberti, Gloria, Giulio E. Lancioni, Nirbhay N. Singh, Mark F. O’Reilly, and Jeff Sigafoos. 2025. "Supporting Functional Occupation of People with Moderate Intellectual Disability and Blindness Using a Smartphone-Based Technology System" Disabilities 5, no. 4: 96. https://doi.org/10.3390/disabilities5040096

APA Style

Alberti, G., Lancioni, G. E., Singh, N. N., O’Reilly, M. F., & Sigafoos, J. (2025). Supporting Functional Occupation of People with Moderate Intellectual Disability and Blindness Using a Smartphone-Based Technology System. Disabilities, 5(4), 96. https://doi.org/10.3390/disabilities5040096

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