People with mild-to-moderate intellectual disability and sensory impairments (i.e., blindness or hearing loss) may experience major difficulties engaging in functional daily activities independently (1–6). Indeed, they may be unable to determine the right time for the activities and fail to take initiative and start to perform them (7–9). Their situation can also be complicated by their apparent inability to remember all the steps of the activities and/or the steps’ correct sequence (10, 11). As a consequence of the aforementioned challenges, people with intellectual and sensory disabilities tend to be largely sedentary and passive with negative implications for their self-confidence, constructive engagement time, environmental sensory input, and social status (6, 12).

This negative perspective has created strong consensus on the need to find strategies to help them reach a more active and functional role within their daily contexts (11–15). It is also increasingly clear that aiming to enhance their activity engagement through extended staff assistance may not be feasible or desirable. In fact, staff resources are known to be generally limi-ted and probably insufficient to guarantee the necessary level of supervision. Moreover, an increase in the level of staff support/supervision would counter the people’s personal development in terms of self-determination, self-regulated engagement, and social image, and thus might prove detrimental (16–18).

In light of the above, efforts to increase people’s activity engagement have largely focused on providing them with activity support tools suited to their conditions (i.e., tools encompassing the step instructions of the activities to be performed) and teaching them to use those tools independently (15–20). The most basic tools consist of booklets with pictorial representations of objects related to the activity steps (i.e., with visual cues the people can use to help themselves remember the steps and their sequence) (20, 21). Other tools involve the use of technological devices (often modified for the purpose of the studies) such as (a) verbal recording devices that the people can use to obtain verbal instructions concerning the activity steps (5, 22–24), (b) simplified computer-aided systems, iPods, or video devices that the people can use to obtain static or dynamic visual instructions (i.e., pictures/photos or video clips illustrating the activity steps) (25–28), and (c) simplified computer-aided systems that automatically show (i.e., at preset time intervals) static or dynamic visual instructions for the activity steps (29).

Studies assessing the effectiveness of the aforementioned tools have reported encouraging results, that is, people appeared generally capable of using the tools to carry out multistep activities independently. It is noteworthy that, in contrast with the efforts to support the people’s independent performance of complex/functional activities, almost no attention has been paid to investigating whether they could also be helped to start those complex activities on their own, at the appropriate times (i.e., with a further enhancement of their active role) (30, 31).

In a recent, preliminary study aimed at pursuing both the aforementioned goals (i.e., enabling people to perform relevant multistep activities and also start those activities independently at the appropriate times), Lancioni et al. (32) compiled a technology-aided intervention relying on a smartphone and a tablet. The smartphone was set up to deliver timely reminders about the activities the participants were to carry out and the tablet served to present the participants the pictorial instructions for the steps of those activities. The results showed that all three participants managed to start the activities at the right times and carry them out correctly, thus suggesting that the intervention was suitable to achieve both target goals.

Notwithstanding the positive results of the study, caution is required in drawing conclusions given the small number of participants involved and the fact that the technology arrangement and instructions used would not be suitable for persons with blindness (33, 34). New research efforts to overcome these limitations and confirm the plausibility of targeting both goals (i.e., independent timely start and independent performance of relevant activities) are warranted. The present study was one such effort involving eight participants with intellectual disability, four presenting with blindness and the other four with hearing impairment. A smartphone intervention was used with each of them. In practice, each participant was provided with a smartphone, which was set up to (a) deliver verbal or vibratory and visual reminders at the times in which the activities were due and (b) present verbal or pictorial instructions for the single steps of those activities.

The panels of Figures 1 and 2 summarize the baseline and intervention data of the four members of Group 1 and the four members of Group 2, respectively. During Baseline I, the participants’ mean percentages of activities started correctly were 0 or close to 0. During Baseline II, the participants’ mean percentages of activity steps carried out correctly were below 30. During the intervention phase (i.e., following the five to seven practice sessions that are not reported in the figures), the participants’ mean percentages of activities started correctly per session were (nearly) 100. That is, the participants responded to all smartphone-regulated activity reminders or missed only very few of them (i.e., five or less in total). The mean percentages of correct activity steps per session (i.e., across all the activities available within the session) increased to near or above 95 for all participants, with no apparent difference between Group 1 and Group 2. Comparisons of the intervention with the Baseline I and Baseline II session data on correctly started activities and correct activity steps, according to the PND method, showed indices of 1.0 for all participants (i.e., all their intervention data points on each measure exceeded their baseline levels).

The results of this study indicate that the smartphone intervention was effective in helping both groups of participants to correctly start and carry out the activities scheduled during the sessions. Indeed, all participants seemed to respond successfully to the reminders and activity instructions presented by the smartphone, thus showing clear performance improvement compared to the baseline periods. Moreover, the participants seemed to enjoy the sessions and their activity management (i.e., start and execution) with the support of the smartphone, as indicated by a number of informal reports, which underlined their eagerness to be involved in the sessions and their satisfaction with their activity engagement. In light of the above, a number of considerations may be in order.

First, these data confirm preliminary, pilot findings and show that persons with mild and moderate intellectual disabilities and sensory impairments can manage the independent and timely start and correct performance of relevant activities through the support of technology (32). Although caution is needed in drawing general conclusions given the relatively small number of participants involved in this study, one could still argue that the data reported here add considerably to the evidence previously available (33, 34). Indeed, these data might be taken as a new, encouraging reference for education and rehabilitation contexts in charge of people like the participants of this study.

Second, the smartphone intervention allowed one to arrange verbal stimuli or combinations of vibratory and visual stimuli as activity reminders. Those reminders, which were deemed suitable for individuals with blindness and hearing impairment, respectively, proved highly effective with the two groups of participants involved in this study. Similarly, the smartphone could be fitted with audio or visual files and thus serve as an effective instruction tool for all participants irrespective of their type of sensory impairment. This versatility of the technology, and its accessibility (commercial availability) and affordability can be considered great practical advantages that may enable education and rehabilitation contexts to successfully set up intervention programs for persons with different requirements.

Third, in addition to being flexible and affordable, the smartphone intervention is also practical to use for participants and staff. Participants who rely on verbal reminders and verbal instructions may not need to carry the smartphone with them. It is sufficient that they wear a wireless Bluetooth earpiece during the sessions (as it was done by two participants in this study). Participants with hearing impairment need to carry the smartphone with them. Carrying it enables them to readily perceive the reminders and see the visual instructions. The smartphone can be hanging around their neck or can be attached to their belt, in line with their preference. Staff can easily modify audio or video files in terms of content or time intervals and thus can make intervention adjustments in relation to participants’ general skills and progress.

Fourth, successful performance with the smartphone intervention probably increases the participants’ levels of self-confidence and satisfaction (41, 42). These aspects may contribute (together with the social approval following the performance of the activities) to ensure maintenance of positive activity engagement (43, 44). The participants’ new performance skills might also be seen as instrumental in facilitating a higher level of approval and appreciation from their education/rehabilitation and social context with potentially beneficial consequences for their mood and overall quality of life (45–47). While all these statements appear quite reasonable in light of previous literature and informal observations, research still needs to address them directly to determine their accuracy (42, 45).

Fifth, a main limitation of the study is the relatively small number of participants involved. Obviously, new studies with additional participants are required to verify the suitability of the smartphone intervention, the reliability of the findings, as well as the maintenance and generalization of the activity skills (33, 34). A second limitation is the lack of a social validation assessment aimed at determining the opinion of staff personnel about the smartphone’s impact and usability within everyday contexts (48, 49). Such an opinion might significantly add to the data and partly predict the future adoption of smartphones within those contexts (50, 51). Another apparent limitation is the lack of reliability (procedural fidelity) checks on the research assistants’ performance. In this study, research assistants’ experience and preliminary preparation were considered the best guarantee of procedural fidelity. Notwithstanding the directness of this view, the use of reliability checks remains a basic methodological requirement (52).

In conclusion, the results indicate that the smartphone intervention was suitable to support correct start and accurate performance of daily activities by persons with intellectual and sensory disabilities. Before general statements can be made about the usability of smartphones, new research would need to address the main limitations of the present study and determine the dependability of the results reported. New research efforts may also focus on (a) gathering formal evidence about participants’ satisfaction with the intervention conditions and their performance (i.e., by recording their preferences or indices of happiness) (53, 54) and (b) determining the overall acceptability of smartphones within everyday contexts (51).

Appropriate institutional board approval and written informed consent were obtained for the study. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

GL, NS, MO, and JS were responsible for setting up the study, acquiring/analyzing the data, and writing/editing the manuscript. GA, CZ, and VC contributed in acquiring and analyzing the data and editing the manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.