Multidisciplinary care is considered the standard of care for both adult and pediatric neuromuscular disorders and has been associated with improved quality of life, resource utilization, and health outcomes. Multidisciplinary care is delivered in multidisciplinary clinics that coordinate care across multiple specialties by reducing travel burden and streamlining care. In addition, the multidisciplinary care setting facilitates the integration of clinical research, patient advocacy, and care innovation (e.g., telehealth). Yet, multidisciplinary care requires substantial commitment of staff time and resources. We calculated personnel costs in our ALS clinic in 2015 and found an average cost per patient visit of $580, of which only 45% was covered by insurance reimbursement. In this review, we will describe classic and emerging concepts in multidisciplinary care models for adult and pediatric neuromuscular disease. We will then explore the financial impact of multidisciplinary care with emphasis on sustainability and metrics to demonstrate quality and value. Muscle Nerve 56: 848–858, 2017

We evaluated the effects of instructive feedback (IF) on the emergence of spoken category names with 2 children who had been diagnosed with autism. IF stimuli were presented during listener discrimination training and consisted of presenting the category name associated with each target stimulus. Results suggest that participants acquired the speaker relations in the absence of prompting and reinforcement. Clinical implications and future research on the use of IF as a teaching procedure for children with autism are discussed.

Advance notice of an upcoming instruction was evaluated to increase compliance among 3 children (4 to 5 years old) who exhibited noncompliance. Results show that the procedure was ineffective for all 3 participants. Advance notice plus physical guidance or physical guidance alone was necessary to increase compliance.

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After a 3-step guided compliance procedure (vocal prompt, vocal plus model prompt, vocal prompt plus physical guidance) did not increase compliance, we evaluated 2 modifications with 4 preschool children who exhibited noncompliance. The first modification consisted of omission of the model prompt, and the second modification consisted of omitting the model prompt and decreasing the interprompt interval from 10 s to 5 s. Each of the modifications effectively increased compliance for 1 participant. For the remaining 2 participants, neither modification was effective; differential reinforcement in the form of contingent access to a preferred edible item was necessary to increase compliance. Problem behavior varied across participants, but was generally higher during guided compliance conditions and lower during differential reinforcement conditions.

Functional analyses were conducted to identify reinforcers for noncompliance exhibited by 6 young children. Next, the effects of rationales (statements that describe why a child should comply with a caregiver-delivered instruction) were evaluated. In Experiment 1, 3 participants received the rationales immediately after the therapist's instruction. In Experiment 2, 3 additional participants received more practical rationales immediately before the therapist's instruction. The results indicate that rationales were ineffective for all 6 children. A guided compliance procedure increased compliance for 1 child; contingent access to preferred items with or without response cost increased compliance for the other participants. Although levels of problem behavior varied within and across participants, they were often higher in the rationale and guided compliance conditions.

We evaluated a method for teaching children with autism spectrum disorder to respond to tactile stimulation of multiple body parts. Various objects (e.g., hairbrush) produced the sensations (e.g., prickly). In a multiple baseline design across participants, participants learned 9 sensation body part tacts and the evaluation concluded with tests of generalization to 3 novel body parts, 6 novel objects, and 3 novel sensations. Participants demonstrated generalization to novel objects, and to a lesser extent, novel body parts, but did not generalize tacts to novel sensations. These findings are discussed in terms of implications for teaching children with autism to tact sensations.

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