ED 057 554

TITLE

INSTITUTION

SPONS AGENCYPUB DATENOTE

EDRS PRICEDESCRIPTORS

DOCUMENT RESUME

EC 040 893

Professional Preparation of Teachers of the MultiplyHandicapped with Special Concern Directed Toward theChild with Both Auditory and Visual Impairments.Proceedings of the Special Study Institute(Pittsburgh, Pennsylvania, June 28 - August 6,1971).Pennsylvania State Dept. of Education, Harrisburg.;Pittsburgh Univ.. Pa. School of Education.Office of Education (DREW), Washington, D.C.7198p.

MP-$0.65 HC-$3.29*Deaf Blind; Demonstration Projects; *ExceptionalChild Education; Inservice Teacher Education;*Institutes (rraining Programs); *laultiplyHandicapped; Program Descriptions; *Self CareSkills

ABSTRACTThe summary of the 6-week Special Study Institute,

which provided professional preparation for teachers to work withchildren with both auditory and visual handicaps, reports zelectedexamples of various aspects of the total program. As part of theInstitute, a 4-week short-term educational program was provided tomultiply handicapped children. The summary offers an overview of theactivities of the Institute and a brief description of the childrenand their educational programs. Reviewed are the content of theinstructional program for teachers, the educational-and residentialaspects of the demonstration program for the children, and the case-histories of the 12 children involved. Appended is an extensivemanual for the development of self-help skills in multiplyhandicapped children. (KW)

0.

U.S. DEPARTMENT OF HEALTH.WIP EDUCATION & WELFARE

OFFICE OF EDUCATION11" THIS DOCUMENT HAS BEEN REPRO.

OUCEO EXACTLY AS RECEIVEO FROMkell THE PERSON OR ORGANIZATION ORIG.MATING IT. POINTS OF VIEW OR OPIN-IONS STATE"? 00 NOT NECESSARILYREPRESENT OFFICIAL OFFICE OF EDU-CATION POSITION OR POUCY.

-

tr.lir

LU SPECIAL STUDY INSTITUTEJUNE 28-Au GUST 6, 1971

0

PROFESSIONAL PREPARATION OFTEACHERS OF THE MULTIPLY

HANDICAPPED WITH SPECIAL CONCERRDIRECTED TOWARD THE CHILD WITHr-

BOTH AUDITORY AND VISUALIMPAIRMENTS

DEPARTMENT OF SPECIAL EDUCATIONAND REHABILITATION

SCHOOL OF EDUCATIONUNIVERSITY OF PITTSBURGH

PITTSBURGH, PENNSYLVANIA

1

SUMMER 1971

t-,

SPEC I AL STUDY I NST I TUTE

J une 28-August 6,1971

TOPIC: PROFESSIONAL PREPARATION OF TEACHERS OF THE MULTIPLY

HANDICAPPED WITH SPECIAL CONCERN DIRECTED TOWARD THE

CHILD WITH BM AUDITORY AND VISUAL IWAIRMENTS.

CONDUCTED BY :

Pennsylvania Department of EducationBureau c4 Special EducationUniversity of PittsburghWestern Pennsylvania School for Blind Children

FUND I NG SERV I CES

Public Law 91-230Public Law 89-313Regional Deaf - SI ind Center

I INTRODUCTION

II PERSONNEL

III INSTRUCTIONAL PROGRAM 7

11 DEMONSTRATION PROGRAM

CONTENTS

4

II

EDUCATIONAL PROGRAM II

RESIDENTIAL PROGRAM 16

V THE CHILDREN

VI DISSEMINATION

. , OOOOOO . 19

ACTIVITIES OO 24

APPENDIX 27

3

INTRODUCTION

The primary purpose of the six-week Special Study

Institute was to provide professional preparation for teachers to

work with children who have both auditory and visual impairments.

Secondary purposes were to provide children with a four-week

short-term educational program and to demonstrate this program

to the professional community.

Three proposals were submitted to support the Institute.

Applications were made to the Pennsylvania Department of Education,

Bureau of Special Education for funds from the Regional Deaf-

Blind Center to support consultants to the program, and for fUnds

under Public Law 91-230 for students' stipends and support funds.

The third proposal under PUblic Law 89-313 was submitted by

the Western POnnsylvania School for Blind Children to support

the residential program for the children.

Participants for the Institute were selected by a committee

from the Department of Education, Bureau of Special Education and

the University Faculty. Applications were received from through-

out the state. The thirteen selected participants were from

public and private day school programs, residential schools

for both the deaf and the blind, a state home and residential train-

ing school, and a private rwsidentialfacility for the multiply -

handicapped. Included in the group were an occupational therapist,

4

2.-

a graduate child development specialist, a graduate student,

a pre-school specialist, and an orientation and mobility

specialist in addition to teachers of the-deaf, witipty

handicapped, and visually handicapped.

Referrals of children were accepted from the Pittsburgh

Branch of the Pennsylvania Association for the Blind; the

Pennsylvania-Department of Welfare, Office for the Visually and

Physically Handicapped; the Pennsylvania aapartment.of Education,

Bureau:of Special Education; local and residential schools; aul

a state home and training schwi. A screening cliniC Was

held in the early spring to observe the children and to gather

basic information about them. The clinic was staffed by the

primary consultant to the Institute, administrators from the

Western Pennsylvania School for Mind Children and the University

Faculty. Twelve children demonstrating a wide range of abilities

and handicaps were accepted for the program.

Consultants responsible for instructional material and

demonstration were all selected from the George Peabody College

for Teachers, Nashville, Tennessee. This decision was node to

assure continuity between the philosophy and theoretical bases

presented, and the actual demonstration teaching with children.

The University of Pittsburgh faculty.gaire support to the consul-

tants and coordinated Institute activities. Two additional

educational consultants were involved to assist in post-Institute

3.

planning for the children. A pediatric ophthalmologist assisted

in providing medical information to the staff as it pretained

to specific children.

The Western Pennsylvania School for Blind Children

recruited and provided orientatiwi to the child care workers

and nursing staff who were involved in the residential aspects

of the program.

This summary of the Institute reports selected examples

of various aspects of the total program. it is descriptive in

nature to provide the reader with an overview of the activities

of the institute and a brief description of the children and

their educational programs. All the participants in the Insti-

tute contributed the material included in this Summary Report.

R. L. P.

II

PERSONNEL

UNIVERSITY OF PITTSBURGH FACULTY

Department of Special Education and RehabilitationEducation for the Visually Handicapped

Ralph L. Peabody, CoordinatorMary W. MboreBruce B. Blasch

CONSULTANTS

George Peabody College for TeachersDepartment of Special Education

Verna Hart - Assistant Professor, Coordinator,Program for Multiple Handicaps

Carlene Dallinga - Coordinator of Evaluationand Treatment, Peabody Deaf-Blind Center

Virginia Smith - Head Teacher, A Team TeachingPracticum for Teacher Preparation In MeltipleHandicaps

Manuel Martinez - Teacher, A Team TeachiqgPracticum for Teacher Preparation in MeltipleHandicaps

Mary T. Young - A Team Teaching Practicum forTeacher Preparation in Multiple Handicaps

Pennsylvania Department cf Education, Bureau ofSpecial Education

Elinor Long - Supervisor, Programs for the VisuallyHandicapped

Western Pennsylvania School for Blind Children

Janet G. Klineman - Educational Director ofLower School

4.

Pediatric Ophthalmologist

David Hiles, M.D.

Participants

Mrs. Elizabeth DePiero - Teacher, Blind Multiply-Handicapped Children, Western PennsylvaniaSchool for Blind Children, Pittsburgh, Pennsylvania

Mr. Andrew Frazier - Mbbili+y Instructor, AileohenyCounty Schools, Pittsburgh, Pennsylvania

Mrs. Merle D. Griff - Child Care Worker, WesternPennsylvania School for Blind Children, Pittsburgh,Pennsylvania

Miss Janalyn F. Haas - Therapeutic Activities Worker0 Western State School and Hospital, Canonsburg,

Pennsylvania.

Miss Margaret V. Henderson - Teacher, Visually Handl -capped Children, School District of Philadelphia,Pennsylvania

Miss Eileen C. Kalbach - Teacher, Visually HandicappedMbntgomery County Schools, Norr!stown, Pennsylvania

Miss Gail McClelland - Teacher, Blind MUltiply HandicappedChildren, Upsal Day School for Blind Children, Phila-delphia, Pennsylvania

Sister Edna Marie Meyers, S.C. - Teacher in Special Educa-tion - Deat, The DePaul Institute, Pittsburgh, Pennsylvania

11Mrs. Elaine S. Mbore Teacher of the Deaf, Primarf

Department, Western Pennsylvania School for the Deaf,-

Pittsburgh, Pennsylvania

Mrs. Gayle Park - Director - Title V1-A, PreschoolItinerant Program for Visually Handicapped, AlleghenyCOunty Schools, Pittsbur3h, Pennsylvania

Mrs. Anna M. Reynolds - Student, University of Pittsburgh,Department of Special Education and Rehabilitation,Pittsburgh, Pennsylvania

8

6.

Miss Linda G. Sension - Teacher, V!-.ally HandicappedElwyn Institute, Philadelphia, 1,6ngsylvan1a

Miss Ann F. Ziionis - Teacher, Resource Room for theVisually Handicapped, Pittsburgh, Pennsylvania

WESTERN PENNSYLVANIA SCHOOL FOR BLIND CHILDREN

Administrative Staff

Alton Kloss - SuperintendentRegis Ferson - Assistant SuperintendentRobort Hughes - Administrative AssistantJanet Klineman - Educational Director of Lower School

Residential Child Care Workers

Alvin ElinowSusan ElinowSherry GlennWilliam JewettRebecca KiziriJames LenknerFr.ed Steinberg

Jacqueline Williams"Joanne Cuccaro (Pennsylvania Office for the Visually

and Physically Handicapped)Richard Giardino (Pennsylvania Office for the Visually

and Physically Handicapped)James Millword (Pennsylvania Office for Visually

and Physically Handicapped)

Nursing Staff

Helen SantilloMery ShariefAnn Useller

INSTRUCTIONAL PROGRAM

.Dr. Verna Hart of George Peabody College for Teachers

conducted the instructional program during the (irst two

weeks of the Institute. She presented the characteristics of

the children being studied, and the theowetical background

for the methods to be used during the demonstration period of

working with children, and described the techniques involved.

The participants reviewed pertinent literature to supplement

the didactic aspects of the program. Many training films and

slide presentations were included to demonstrate both charac-

teristics of the children and specific methods utilized in

their education. Materials provided by Dr. Hart were distri-

buted and a selection of these materials are included is

Appendix A.

The following log is included in this report for the

purpose of indicating to the reader the comprehensiveness of the

program. It merely indicates "bare topics" and not actual content.

The following log is included in this report.

LOG

6/28 Overview of the institute

A look at the multiply-handicapped childCauses of handicaps

Information on characteristics of Rubelia ChildrenCauses of RubeliaPrevention of Rubella

4i)

,

r

8.

6/29 Characteristics of Rubella Children - continued

Vitteo tape of child in testing and observationsituation

Discussion of techniques used for teaching communication

6/30 What to look f3r in an evaluation report

1. Heart2. Eyes3. Ears4. Teeth5. -Gait6. Social history

.7. Psychological reports

On Educational evaluation

I. Mbdality of learning2. Body Image3. Locomotion4. Memory5. Speech and language development6. Socialization

Video tapes of seven children demonstrating differentdevelopmental patterns

7/1 Evaluation instruments

The team approachA RationaleIn teachingSelf careMbtor skillsAdaptive behaviorComiunication

Characteristics of Epiliptic Children

Introduction to precision teaching

Video tapes of two chi ldren In a feeding programand of a group activity

Steps in forced feeding.

\\I

9.

7/2 A review of normal child dvelopment

The uses of charts and manuals to assure ccusistencyin training children (Examples included in othersections of this report.)

Slide presentation of a feeding program

The autistic child and autistic tendencies indeaf-blind children

Basic mobility techniques with blindfolds andspecial glasses (Presented by Orientation andMbbility Specialists --Bruce Blasch, Andrew Frazier,and Kathy Daugherty)

Introduction to manual communicaticn

7/6 Comparision of early rubella children with thoseof today

Care of a child in braces

CUrriculum concepts

Body imageSensory discriminationConcept developmentDirectionalityMeasurementTimeClothingEatingGroomingHousehold furnishings

. FamilyVocabularyincidential learningPhrases

Brain injury and its implicationsAphasia

Handling behavior problems

Video tapes of classroom group activities

12

10.

7/7 Cerebral Palsy

TypesHelps - Special Equipment

Brain Injury

Medication and structuringTadoma Method for deaf blind children

Video tapes of childrenlb be in four weeksdemonstration program, noting how they functionalone, with stimulation, in a structured situationand how they relate to people.

7/8 Precision teaching

Pinpoint behaviorRecord behaviorCompute rateChartChange

Further observation via video tapes of children tobe in Demonstration Program

7/9 Precision Teaching

RecordingChartsTime probesTolleting

Assignment of children to teachers and formation ofteams

Development of schedules

Planning first week's activities

4

J.

DEMONSTRATION PROGRAM

The demonstration aspects of the Institute consisted

of two related pn3grams. Daily from 9:00 A. M. to 3:30 P. M.

the Teacher-Participants with the consultants from Giorge

Peabody College for Teachers worked directly in the educational

program with the children. Each afternoon from 3:00 P. M. to

3:30 P. M. the Teacher-Participants conferred with the Child

Care Workers to assure consistency in contacts with the children.

Then from 3:30 P. M. until 9:00 P. M. the Residential Staff

were responsible for the program activities for the children

and provided training and supervision within the dormitory.

EDUCATIONAL PROGRAM

The educational program primarily concentrated on

three curricular areas:

Adaptive Behavior

Motor Skills

Communication Skills

The education program for each child was based on

functional levels determined through observation, and utilized

such materials as "A Manual for the Development of Self-Help

Skills in Multiple Handicapped - Experimental Edition" (See

Appendix A). Traditional evaluations were not made, although

previous records were available for reference_purposes.

A daily schedule was developed, and periodically revised.

A dTfferent Teacher-Participant planned the daily tofal group

14

12.

..111I

activity on a rotation plan following a weekly theme.

Small group activities were conducted within a team-teach-

ing structure in three curricular areas. Teachers Partici-

pants were assigned specific children with whom they were

to work the first week. Although they were reassigned to

other children for individual sessions periodically through-

out the four week session, each child retained his original

teacher for two short periods daily.

An activity which presented particular difficulty to

more than half of the children was eating. A number of the

children, for example, had not previously experienced solid

foods. Therefore, the teachers actively participated in the

feeding program. As In other aspects of the program, the

assignment of children to teachers was periodically changed.

Through the periodic reassignment of Teacher-Participants

to various activities and children, the Teacher-lodrticipants

were assured a much greater range of experiences. This pro-

cedure made it possible to have direct contact and responsibi-

lity with both the most complex children as well as tnose with

less serious handicapping conditions. This policy also contri-

buted to the primary purpose of the Institute, that of providing

professional preparation for teachers. Safeguards were built

into the program to assure consistency in working with the children.

15

1v;. I

13.

The educational program was specifically designed for

the individual children in tne program. Therefore detailed -

descriptions of the total program would be inapproprie3 in a

report of this nature. However, examples of the recording

procedures for special behavioral objectives are included to

demonstrate the practice of pinpointing minute objectives.

Figure 1 shows the progress (in grooming skills) of one

of the more competent children (See Appendix A for complete

manual). When the child is already competent in a skill an

X is put in the appropriate square on the chart. When the

child is working on a particular skill, a circle is put in

the box. When a task has been accomplished, an X is put

over the circle.

16

t

SELF HELP DEVELOPMENT

GROOMING SKILLS

WASHING

LEVEL 1 - The child:

1. Shows interest in playing in the water; permits hands tobe washed and dried tiiiirirlig1101121111:::7

2. Shows interest in faucet and stopper WWWWLEVEL 2 - The child:

3. Locates rink 1MMM0104. Locates faucet tiii04040S. Turns water on

6. Wets one hand

7. Ve ih hands.

8. Locates soap

4,CD..._ 441100k 4411:= 441110l 4kr.:.=.. J,

Illgai"Ca-M

9. Gets soap on hands

ILEVEL 3 - The child:

10. Rubs soap nn hands

11. Rinses hands

12. Locates faucet

13. Turns water off

.-v., -

a.... i... Pr'.

14.

ltS.

LE

VU

: 4

16.

17.

18.

LE

VE

L S

19.

20.

21.

22.

23.

24.

23.

26.

27.

-It

GROOMING SKILLS (cont.)

Locates towel

A.;

leAq,

440(10440n.

21 7-° n °Z;

0074'.g.b"-*° s!.: 11

.4.0404.0.124,o6.14,4$4

rl *A .04000110

MIA

PP)Z00);

.ell..1q4

;1; 11 PC:

vs

(174

we

r we

I

:1!..:

tqw-,s,

2v..22ma*

a-4.z

ou.moroou,

V040000

ZW

U=

Z>

e=2

4. :4i

073

A': w

:.w.r..

...I

V4

a...%.17s=w

..4"00nzo-ow

OC

OC

:70O4."44

Takes

towel

4W11

. The

child:

Dries hands

M*M

.-sumilipp--

11111111''. 441111ralW

iiih.."Iiiiiiiiiill_...%.1,1-

MIR

OIA

PP

.-

IMM

E kl141

, . 1i

_IPP

-.-....w

.--__Aiii...411.- _

Locates waste basket

...........T

hrows tow

elaian p it u.447I

Iils.1....01b..the child:

.

Turns

ohot

andcold faucets

for warm

water

.11k4.5.7241 4a.

pp; ...;... .-...,

Washes

his hands at the 2

ro riate tirep...de

endjit. ..,y10.

k1114klabigq...14°.dlisa,ki_aiii..-1111120111P

P"-

r4v,44111101110i01....

100

PraisPP.....-0--

Gets washcloth wet

Itatelseon cloth

Washes face

not ears

Rinses cloth

Rinses face

7..*Wb.

7114,

Rinies cloth andift

.

_,...also._P

oMia11051

..._..

Rubs

face dry

01!"1111,1-111,11±11111111.1.111L11111"111.111.11111MIMMEr."--..:.

MEL 6 - The child:

28.

Washes face 1.:t appropriate times

29. jams self assisted with preparing

and touchin

LEVEL 7 - The child:

30.

Pre ares .bath water

31.

Bathes self initteldtah_;

4ilm

a$

Va,.^V

r4-

51g fitfla

+2.

;.g

11

5I

1.3fr

C.

OO

5 7OU

013

g (n)111

41 -;11.)

pia

P'11

40) .C 12

.04:10

P,11

1.)14

°P4

1,444

P4

4 rt .0 41e0etu 4.4

MC

I.C

Ote U

.CZ

mlIMMIWOmmie

14.

"Probe Charts" (See Figure 2) were used to record

specific behaviors. These charts were utilited for both the

elimination of undersirable behavior and the development of

new behavior. Precise observation and timing were necessary

to determine the progress of the behavior probed. The follow

ing chart demonstrates the ability of the child to attend to

the task on a simple game.

Each "Probe Chart" was then put onto a graph to show

instantly gains orlosses which had_ taken place. The activity

depicted on the graph (See Figure 3) is of a child in a simple

auditory activity.

1po+ Jetiknvi.

on sfickwhs plotegien hand

IName Behavior

Jimmy

Setting

41

Fltgrommwi,ortiovoornmirql,

'PROBE CHART

Numberof

movements

".* 7r- arr -

Rate

On +he,i4lok t.00tp.

skat I P.osistinmovetwat

4' 1 1.S 4:tr S.3 Oat

10

1.5

I 1

MUMMEMMEMMUMME UN EMMEMMEMME IL II

N M IEEE

mm111111 ' U

MI I EMMEMMimmilim mum

E N NM Mill NU LLE1111111111FREM URN NUM

IMIlliMINM OME mum MIN 1.11% INNIMill IMUMME11111=111

11111 1111110,111=1611111

1 MIMI IN MEM

f

A A MIIIN 0111V7PWIt .

MI 111111 M A I

MEM= I L..1111 I e MIRM II MEM= 1 Millimimarbil

_ _ OM UM IMMEMIMA i M M RP MMIOMMEMMIM

kga AAA mummmu virall miiimAimA14

1 NEM IN NMI I I MIR IL 1 1

NEW. ME M I =MUM r I

ME MEAN MAIM MUM' IIMMINIRM in MEM=

MI M m

ImmeEMME MUM Mr= JR IIIIMMEMMIt MEMMIEU mk M MUM= MIA 1

1111111111MIMINIMIIMMINIMINIMEIMMEMEWIMINIMENIMIN EE 0 MIL MEMIMMIIMMEMME mu MEMO =WM =MOM ME UM IIM 11111 IIIIII! ON MEM MN MN mall M L

MIMI WM MEM mull mm MEE MEMEMEOIMME M MI MEW. MEM= MMEMMEMM

IIIM MINIUMMEMEMMEMINIMMEMMEMMEMMI MEM II IMMENEM ME MN AMMEMMEMEMEMEMEMEMM MIIM 1 Irma num . .............m. . mum.

..m.....m...N.L .1.1 mum mill ingammul II .......m.......... .. 1.... . IMMINIMEMINIM I

IIMMEMMEMMEMMEM =EMI MI ME= MMIUMMIUMM MIM mmumEMMMEMM MONA MO=

MMEMMEMEMMME INIMMUMM WI= m 1

MMIIMMEMEMMEM MEM =LIMA. a I MIN IP il 111

MEM 1111111111MENIMMIEMUMI MEM MEM

MINIMMONEMMOINMEMME M M MMOALlingi

Illorrorr

15.

Toileting Charts (See Figure 4) wore kept 24 hours

per day seven days a week (parents cooperating on weekends)

for all children not toilet trained. The following symbols

were used on the charts:

W - Wet not on toilet

S - Soiled not on toilet

0 - Placed on toilet without any success

01)- Wet on toilet

Soiled on toilet

The following chart shows a child with a tendency toward a

set pattern of urination by the clusters of WIs. After rather

random placement on the toilet without success the pattern

was recognized and as can_be seen the child had nearly complete

success by tne fourth week of the program. Charting the behavior

in this manner aided in establishing the pattern and training

the child.

23

I-11 11 1111

II 1111111

I 7 UN I!!I IAZWIr4 APIPBArAr. AWAr r

. _..

*. . . . 1231 MI.

II31IIII2 NMI 211 11E111 II

11111111 31111 11:11 Inn 1

Aitav.rA0.2ur ArAMArAr Air.40-AwAfArArArAtwAnwdI

17-

11 1111115, g p

r4rA 7.._=.7_.- . Ar I CI-&.M.r A IPM-2 I Al l IICa 7

1 1111 11111 1 1 AI EN NIIIra11 annum III I

11 I 11Inil

lif==

M//////7//////////////77/77///// /

t 1-11-11-11-11-11-1

0°000ow,WWWWWW*0417041.01WWWwWW 1.01.0.4.0N1-104.01.0.WWWWHOLA.C.WN a 1114.7r-m.

itor

.0.47A4:760..0,,O,CoClo.SZI.O.CLCK.O..04.0.,12.42

111111 111111

1 11 1 III 1 111111 1111111'

illif 1 1111111 111171111M a

_.,:eitr4r4r4rIVAW.AnMn'rAMW/r' WA' "RIPHILLL 11113 1111131111I2111

11111 .11111!1IIII I

-

111111

1111111311111111311 .'" I111111 II

Asr-Ar Ar41-02-rAW r-0r.dr44 PAr- 4.4Ur vIt5M*5.**S-&AcrirA 12111IIIIIMI

I111!1 I

51 Mel 1113111

NUMMI

11

In

11 I

I Ir 111111111 MENU WO!. T MEMMEMMEMMEMM

I 1

1 IIIIIIIIIIIIIIII II

I

I ///7 1/1/ /7/1/ / 7 //// / / / I.

**WM

. OM

,V

INIM

Ma

ON

O

...ea4

4 4

M..

..4

s.

...MS

.a a

0.S 1.

.1110

.M.A

...0

OM

OS

s

401.8.

-

MO

. ..411.

ob

.00 41.

.

SI111.1.O

M,

es..V

%W

NW

4 MN

vs

.011

as......las M.....

NM

NU

EN

EN

11111 INN

MN

MN

INN

NM

OS:9

OC:9

OZ:9

OT:9

00:9

05:5

0:S

OC:S

OZ:S

OT:S

00:S

OS:

0:f7

OZ:f?

OT:f7

00:fi

OS:C

017:C

OM'

OT:C

00:C

OS:Z

0:Z

OZ:Z

OT:Z

OS:T

OC:t

OZ:T

OT:T

00:T

OS:ZT

0:ZT

OC:ZT

OZ:ZT

OT:ZT

00:ZT

OS:TT

0:TT

OC:TT

OZ:TT

OT:TT

00:TT

16.

The proceeding charts as well as other rather detailed

records were kept on all the children. These will be for-

warded to appropriate agencies and schools as the children

are placed in programs.

RESIDENTIAL PROGRAMS

Residential care for the (twelve) multiply handicapped

children was provided at Western Pennsylvania School for Blind

Children. This aspect e4 the project, directed by Dr. Janet

Klineman, followed the objectives and procedures planned and

supervised by the consultants and staff members of George

Peabody College for Teachers and taught by the consultants

during the in-service training sessions.

Eight child care workers lived on the campus and pro-

vided the follow-through program from 3:00 P. M. to 9:00 A. M.

Sunday afternoons through Friday mornings. (Arrangements had

been made for all the children to be with their families over-

the weekends.) The educational backgrounds of the child care

workers included the study of child care and development, psycho-

logy, education, and music. Four child care workers' were members

of the Title 1, 89-313 project for multiply handicapped blind

children at Western Pennsylvania School for Blind Children in

1970-1971.

27

17.

In order to provide the necessary one-to-one relation-

ships with the children, the child care workers were assisted

by case workers from three district offices of the Bureau of

Visually and Physically Handicapped, two practicum graduate

students from the University of Pittsburgh Special Education

and Rehabilitation Department, and a volunteer from the

Western Pennsylvania School for Blind Children staff.

Each member of the residential staff met with a member

of the instructional staff daily at 9:00 A. M. and from 3-00 P. M.

3:31) P. M. to share information about their particular child and

to exchange self-care charts and tolleting records.

The residential staff provided a nurturant and consis-

tent environment for the children. The children seemed to

naspond favorably to the use of positive reinforcement tech-

niques. Each staff member close to work with the same child

throughout the project and was encouraged with each small gain

demonstrated by the child.

Each staff member wrote a weekly evaluation report

to summarize the objectives for his child and to note specific

outcomes. The evaluations revealed the children's adjustment

to the new environment and their improved performance in the

areas of self-care skills, communication, and motor skills.

The case workers from the Bureau of Visually and Physi-

cally Handicapped were involved In the actual work with Individual

4=liBMI

children, attended staff meetings regarding the children and

their problems, and observed the children during the in-service

training sessions for the teachers.

This summer project provided the residential staff

with learning opportunities in planning, caring for, and teach-

ing multiply handicapped children who functioned at very low

levels of development. Positive attitudes and expectations

for the development of educational programs for such children

were expressed by the staff members.

29

THE CHILDREN

The following descriptions of the childre, lapresent

very base tine data. The information is primarily summaries e4

case histories which were available at the start e4 the program.

As has been previously indicated records were kept for each child,

and these will be made available to referring agencies. However,

as the purpose of the Institute was demonstration and not evaluation

of children or methods, the children's progress is not indicated

in this report. The purpose e4 the descriptions is to provide the

reader with a general impression of the children included in the

program. Where the test scores are included in the descriptions,

these were extracted from the children's previous records. Traditional

evaluation procedures such as testing were not included as a function

of the Institute.

Child A - Boy Birthdate: 8-12-67

A lives at home with his natural parents, an older brother,

and a new baby brother. He was a pre-mature baby and has retrolental

fibroplasia. He has rather well developed motor skills, no language,

is not toilet trained, and indulges in much self-stimulating behavior.

When he entered the program he was bottle fed and did not eat solid

food. A Maxfield Burcholz Social Competency Scale for Blind Children

was administered April 18, 1971, and A was scored at the 1 yr. 6 mos.

level. His hearing Is qmestionable, but may be normal.

Child B - Girl Birthdate: i2-15-65

B Is the third child in the family, having two older brothers.

She is a rubella baby who is profoundly deaf and cerebral palsied.

369

1

P8

20

She has limited vision, wears glasses and a hearing aid and walks

independently with two tripod canes. B is not toilet trained, she

does feed herself independently. B has been tested with the Leiter

International Performance Scale. She received a score cf 78 with

variability, which indicates that she is educable. She has attended

an Easter Seal Preschool Program for deaf children, and is able to

lipread at least enough to follow simple commands and has a verbal

vocabulary between 40 and 50 words.

Child C - Girl Birthdate: 10-22-65.=.C lives with her mother, step father, a younger sister and

brother. She was a premature rubella baby with some history of

seizures. Her records indicate inconsistent audiblogical test results,

microphthaimia, strabismus, and probable mental retardation. She

is hyperactive, has no speech and no awareness of symbolic sign language.

Child D - Boy Birthdate: 7-29-65

D lives in a foster home with tvo foster siblings. He is

a rubella baby with possible serviceable hearing in his right ear.

He had bilateral congenital cataracts which were extracted. He has

no speech, is not toilet trained but he can feed himself solid food.

He has good motor skills but nc self help skills.

Child E - Eby Birthdate: 3-24-65

E lives with his mother and 8 brothers and sisters. He was

a premature baby and has retrolental fibroplasia. He is retarded due

to prematurity and environmental deprivation. He apparently has no

light perception. He is partially toilet trained, feeds himself solid

31

21

food and has a few self help skills. He has a retarded language

development approximately two years behind his chronological age.

Child F Boy Birthdate: 2-11-65

F has parents and two brothers at home but for the past

three years he has resided at a Children's Rehabilitation Center.

He is a rubella baby with partial hearing, congenital heart disease,

profound retardation mentally and physically and extracted cataracts.

He is got toilet trained does not walk independently and has little

self help skills. He does, however, feed himself solid food. He

has no speech, only uttering gutteral sounds. His behavior is

restricted to self-stimulation. Psychologically, he earned a Cattell

score of less than 15.

F will probably continue to live in the institutions and

eventually have a terminal placement arranged.

Child G - Boy Birthdate: 11-9-64

G is a rubella baby who was adopted by a nurse. Shortly

after the adoption, the husband of the nurse was killed. G and his

adopted mother now live with a grandmother end two uncles. G is deaf,

microcephalic, and mentally retarded. He has had cataracts removed

but has secondary membranes. He has never learned to utilize his

residual vision. He is not toilet trained, cannot feed himself, and

eats only semi-solid foods. He has no speech. His ,psychological tests

indicate an I.Q. of less than 35.

32

SJF-7

.101.11111111w

22

Child H - Girl Birthdate: 1-8-64

H lives with her mother and father and one younger brother.

She is a rubella baby with profound reduction in hearing bilaterally

and congenital heart disease. She has had cataracts removed and,

has useful vision. Her psychological testing reveals intellectual

functioning below 50 percent of normal. She is partially toilet

trained, feeds herself solid food, has good self help skills. She

has no speech and does not understand any.symbolic sign language.

Child 1 - Boy Birthdate: 1-18-63

1 is the fourth son of his parents, having three older

brothers. He is a rubella baby who.is profoundly deaf, blind in

his right eye and probably retarded. It has been impossible to test

him psychologically. He wears bifocal spectacle lenses and a hearing

ald. He is not toilet trained, could drink from a cup and would

occasionally feed himself semi-solid junior baby food. He has no

self-help skills other than being able to remove his own shoes and

socks. He has no speech.

Child J - Girl Birthdate: 9-5-63

J lives with her mother and four siblings. She was an Rh

incompatible baby, has colobomas, abortive aniridia, ootary nystagmus

and myopic astigmatism. She is deaf and wears a hearing aid. She

has very restricted language but responds well to visual clues.

Psychological testing has been unsuccessful. She attends a pre-school

for retarded children where her teacher reports she is cooperative,

likes books and enjoys visual perceptual materials.

33

23

Child K - Girl Birthdate: 7-8-62

K tive OA', her mother and two younger sisters in a

housing project. She has had cataracts removed an4 is severely

mentally retarded. She has little spontaneous speech, is partially

toilet trained, feeds herself solid food, can dress herself. Child K

has attended a pre-school class for retarded children for a few

months.

Child L Boy Birthdate; 3-58

L lives tn a residential state home and r2aining school.

He was a premature baby, is totally blind and severely retarded. His

records indicated that he had a profound hearing loss, but on recent

testing showed some response to loud sound. He feeds himself with

a spoon and eats solid food. He is partially toilet trained and.

can dress himself with a little assistance. He is hyperactive and

in the institution is constantly tre.nquilized.

34

Dissemination Activities

The Special Study Institute summarized in this

report is the first one, concerned with the child with both

auditory and visual handicaps, to be conducted In Western

Pennsylvania Therefore, it seemed appropriate to invite the

professional community to visit the program. All visitors were

given an orientation to the program and an opportunity to observe

the children in the classrooms. The following tabulation indicates

approximate number of agencies or institutions represented and

the position and number of visitors.

Pennsylvania Bureau for the Visually and PhysicallyHandicapped Counselors and caseworkers - 7

Children's Hospital-Developmental ClinicNurse - IPsychologist - I

Pennsylvania Association for the Blind-Pittsburgh BranchCaseworkers - 4

. Administration and Supervision - 3

Cresson State School and HospitalTeacher-Visually Handicapped - I

Western State School and HospitalTeacher-Visually Handicapped - I

Philadelphia Public SchoolsTeacher-Visually Handicapped - I

The Pennsylvania State UniversitySpecial Education Students - 3

Western Pennsylvania School for Blind ChildrenTeachers - 8

Western Pennsylvania School for the DeafPsychologist - I

2'

25

University of Northern ColoradoSpecial Education Faculty - 2

Eye and Ear HospitalOpthalmo!ogist -1

Nurse - I

Westmoreland County SchoolsHead Teacher Program for Visually Handicapped - 1

Washington County SchoolsTeacher-Visually Handicapped - I

Pennsylvania Department of EducationSupervisor-programs for Visually Handicapped - I

Pittsburgh PublIc Schools-Work Experience Program inChild Development

Teacher - 1Students -.21

University of PittsburghSpecial Education and RehabilitationFaculty - 7Graduate Assistants - 3Students - (Deat V.H., COHI) -27

Video tapes, audio tapes and, .35 mm slides were taken

throughout the program. These are to be used for training purposes.

They are available to the Consultants from George Peabody College

for Teachers, participants in th6 Institute, WPSISC staff and the

University faculty. The distribution is restricted to those who

were involved in the program, so that they may provide appropriate

commentary. There are no plans to edit these films for general

distribution.

Although this summary does not include an evaluation per se,

the following outcome of the Instituteprelated to dissemination of

information is included. The prtfessional visitors to the program

recognized its impact on the children. As a consequence, plans are

36

26

presently being made to develop and initiate a continuing educational

program for children with both visual and auditory handicaps in

Western Pennsylvania.

r.-

APPENDIX A

The selected materials included in this section

were prepared and distributed to the Institute participant

by the Consultants from George Peabody College for Teachers.

38

27

1

1

A MANUAL

FOR THE DEVELOPMENT

OF SELF-HELP SKILLS

3241 MULTIPLE HANDICAPPED

CHILDREN

Experimental Edition, August 1971

A Team Teaching Practicum for Multiple Handicaps

George Peabody CollegeNashville, Tennessee

2316

Li

SELF HELP DEVELOPMENT

EDUCATIONAL S"GCESTIONS

In the beginning stand directly behind the child, with your hand on

his. Begin by guiding his hand by holding your hand over his -- as soon

as possible, decrease the amount that you help him by moving your hand

away from his hand to his wrist, then to his arm, and finally just to his

elbow. Hever guide him more than is necessary -- always try to let him

do as much as he can by himself.

Praise or reward the child for any closer approximation of the de-

sired behavior. In eating, an appropriate reward would be a small bite

of food he likes, of dessert, or of the child's favorite food for eating

a bite of something he doesn't like.

USE OF THE CHARTS

Put your child through each of the activities. Color in the chart

squares to indicate what your child can do -- his present level of func-

tioning. The square next to the colored square will indicate your teach-

ing objective. If a child can lift a cup and drink with only a verbal or

tactual cue, the immediate goal is to have him lift a cup and drink with

total independence. Expect spotty looking charts and don't be concerned

about them. They show that the child has not learned the sequence. Your

goal is to teach the child the missing steps by using the blank squares

for your teaching goals. Written procedures falow each of the charts.

29

40

30

The development of Olfactory (smell) and Gustatory (taste) senses should

be incorporated into actual experiences as the occasion arises. There is,

little value in teaching the recognition and taste of these objects apart

from the proper setting.

Take the washing experience, when the soap is first used the child may

be allowed to smell it, thus he can associate its odor with its usage.

Hand creams, perfume, nail polish, shampoo all have high value smells and

can be taught in association with their use.

The names of foods the child eats can be taught during the meal, or

through a lesson on them in the classroom. Follow through activities on

lessons involving fruits or vegetables might include a game whereby a child

must find a particular fruit that has been hidden in the room. This may

include a lesson in mobility as well if the fruits are placed in care-

fully selected spots. Among the items particularly good for such exer-

cises are bananas, coffee, oranges, lemons, chocolate, peanut buttern,

onions, cinnamon or cloves. If the found object is edible as is, then the

object would serve as an appropriate reward, otherwise a stick of gum, II&M

or some other small edible reward ndght prove satisfying.

41

USE OF ASSISTIVE DEVICES - The child is able to:

a. Drink without an adaptive appliance

b. Eat without an adaptive appliance

FEEDING

1.

2.

3.

FINGER F

4.

5.

6.

7.

8.

DRINKING

9.

10.

Yes

Yes No

.10lomm the child is fed, he is able to:

Raise head to eat

1.4

4 .1 t)V 141 i4

A .t" wi 1l0 aim, 000 43 I4 1.401410111V4 la stl ti50121'3)UAIL;VA;3

1.4

I tl9 2CU 0

VA .124 al

4J 1.4

1 1 1X41 C t 1 441

" g 2$41)

0 001.,?47.31

r.,f4 .

1.4

0043o

CtI 313P1

oN1

0111 4.24 .

47000 0ow owal0 0 0CU 4, 4r1mow tri Ad

11 t 1 3.0 43 0

"441 4 tg /4 65 110)

Keep the food in his mouth until he swallows it

MEChew the food if neceskary before swallowing it

0010S - The child is able to:

Eat finger foods when the are ut in his mouth

Hold and eat finger foods when they are .ut in his hand

y1414:Alp_the finger foods and put them in his mouth

Break finler foods into edible .ieces and eat them

11/2-212LA22.12E/illt-gal-Piecee of finger fonds

- The child is able to:

Drink liquids when they are put in his mouth

KeAP the liquid in his mouth until he swallows ie,

4:C.4.1

11.

12,

13.

14.

15.

16.

17.

Nt4 SPOON US

18.

19.

20.

21.

22.

23..

24.

25.

26.

27.

- +1. 41M-. - OW= r -- J.n.... .... _ . ... ..

EATING SKILLS (oont)

..

REL.L._a_lrolkli.Ltidstilittring

'43 ci,1..1

) CO 14;0,0040,00;I

ii 0.00 4.1 3.1 I-Ic0000rl *

1-4 04 4.1

VirggrgicillSitalicillsgal)3m u . ...i

- or .3l 4OS U

71 g ".000OA U01-i01 OS OSV V .0 003

z .0 ..

. . .boo ot9.94 O 4-1rl Uw00

01-100 al1-i

CO 44 tO103 .0 CVO

z a, a

th4Ju

WM

000 r4tO CO

.0til

2 1

c -"'00010

103 aa $.4 103 04.1 0 m LI

J:1 4.1 arl 0 0

440.11 r

Drink from a cu. when it is held for him.

.

Lift a cur) off the table to drink

,

Lift cup, drink .

Lift CUP drink return the cup

.

Lift .a cup off the table with pee hand to drink

Drink with one hand without snillin: it .

M - The child is able to: . .

Be s_600n fed while sitting_ un .

pjLtawsoon when it is held for htn,

Hold and eat from apoon that has been fi'led for him.

Hold and direct a s bon accurately toward food

Hold and filljspoon independetlY MEEMIMI

Direct filled spoon to mouth

Hold a spoon and eat from it allDirect a spoon accurately toward mouth

Eat from a spoon without spilling

Take a bite, put the spoon down and chew MIN

28.

29.

FORK USAG

30.

31.

33.

34.

35.

36.

37.

KNIFE*USA

38.

39.

40.

41.

42.

-...--- --........-----.--,--.-....,,---,....-..--.

EATING SKILLS (cont.)

Nolsinfierosithileeatinfromit

-,4.) t.)

'5 'r04 wpNo1 r4 I

..-1 co 40 ..) 11 *4'000c0ra to 07-11 t ro t

U al 44

*ril 4Ju.00T41 1 "I", 1.1

04 UCr-ien OS ai

1 :5' 11 renZ 60 .0

W)0 Z'prl ' t0000 44r-1 11r-I 00 CO

U 1-1en .14 OS

At' reelZ 04 > .0

0.1..1

c.)00.,..,

6,4 11C 00

1-1en ai

11 0Z > U

0 0ki '000 0 0.4 4.) 4r1

'0 (1) a0 14 in 04400U

1-1 la a)ai ca m&J 1 orl a"

E-4 14 4J Cl/

Fill a spoon with the appropriate spoon foods and tisefi :ere where a..ropriate a,

.

3 The child is able to:

Eat adult foods from a fork when fed

Hold a fork in fi :er .osition

Hold and fill a fork indeem&HUgy______________

Direct a filled fork inde endeutl.

.

Direct a filled fork accuratel

Eat from a fork without s.illiTake a bite. put the fork down and chew

'Ilse a fork or sioon with a..ro.riate foodi

NI - The child is able to: .

Hold a knife in appro.riate fashion for spreadi : $

Spread food .laced on bread

Scoo. from container and s.read

Hold knife in amariatefashion for cutting

Cut if ob ect is held for him

^ -

43.

44.

45.

TABLE

46.

47.

48.

km4=b $pl, 49.

CA50.

51.

52.

3.

54.

55.

56.

SELF SE

57.at

' ... .. s - . --..,-.-:-.--.. --,-,..-,-------761

.

EATING SKILLS (cont.)

."

Hold ob ect with one hand cut with knife

.5 Tor $4P'N 0 04.0 .0 4i

o 00-4cumm1-1 0 X0 .00 4-1 io 1-1'V 0 0 0

eel pZ000,-1 0,, 44

-----aco ' a'0 PO 0el 0 .1.1PN li0 00, C.)

=1-1

m xi coy

a aaI:4 ''' ''0 0 0

0 .1.1aN u

r-1 li0 t,4 00 001-1

04.40co xi -

6-4..1

0 0.1.4

aNr"4 ilC 00

e-I

m .0

- oc0 0 00, 4-1 .0.10C il CO 411

Ot* 1 11 if

Hold object with fork cut with knife

yut knife down sick u. fork for eati :

IERS The child

°bens napkin

Tucks napkin in belt neck or lays on lap

Eats without stuffinumouth

Eats without playing in food.

Does not eat too fast .

Does b,--4' eat too slowl

Bolds silverware appropriately

Kee s elbows off table

Eats with one hand keers other in la. =MEIWipes nouth with napkin.

Excuses self wten leaving table oi waits forothers to finish 11111

'ICE SKILLS - The child is able to: .

Pour Own drink after carton has been opened or frolli

__pitcher

.

53.

59.

60.

61.

62.

64.

65.

pl .1-1$.1

ON 0 04.0 .0 440 04 r-4 41

or't CO .00 .0

0 m) I., .-4To 00 04-4 > Zr-1 fa4 ICI4-40VOW.A0=000000.00000z

,.., 0 44

-1 4.1M Or-I0 110 ottr1 a 4-1M COP.. 44.0 03 )0.. ....

go-403 CO M

°14 .1e4 r-4

Z 40 > .=

r4 CO 4.30

Z 4m30

r-4 k4 4-4 000r-4

03 ,r4 CO

71 ;%. f4 441

Z Ct > «CI

4.304.3

ON4-4 1-40 0003 CO

71 .2 W

Z > 0

'Z'a0Ci. 4.1 r4W

14-th00

4-4 g o

121:1/°:1400.4 0

.'

EATING SKILL (cont.)

.

-

D etp.irg.A...p_______,cur own drink ..,,

Pour without segling__

..

SelecthisontrayaoLsass servina,dishe8 1

Select ap.ro.riate amounts' and kinds of food

..

Carry his tray fo the table Ovr serve self from

LIIIIMAILIEL......

Take back his dtay dishes 1ms..

________

Clean off hIluttEly_dishes

....

.

. .

Put his dirt dishes where the belon:

TEACHING EATING BEHAVIOR-

Objective: The end goal for the multi-handicapped child is the, ability to

eat his food properly and independento.

Testing and Teaching - Swallowing: .Before bejinning to teach a child to feed

himself, be sure he can swallow and chew. He has to be able to swallow in order

to drink liquids. When teaching a child voluntary swallowing, his head should

be held slightly downward. If i cup is being used, do not have it too full,

but be sure there is enough in it so that he does not hsve to tilt his head

back.to get a sip. Place the cup slightly behind the teeth and on top of the

tongue. When the liquid is in his mouth his lips should be closed to :rake

swallowing easier. A finger pressed on the chin helps close the jaw. Gently

stroking the throat helps swallowing. Don't let the child bite the cup. If

the child cannot close his lips around the cup, then hold his lips shct with

your fingers. Two fingers of one hand are held over the lips while the other

hand holds the cup. The child should be taught to take a sip and swallow be-

fore taking another sip. If too much is poured into his mouth at once, he may

gulp it and choke. If the child stiffens when the cup comes near wait until he

relaxes. Ht; will soon learn that he will get food only when he relaxes.

When fed solid food that doesn't have to be chewed, the child must know

how to hold the food in his mouth before swallowing it. This is necessary in

order to move the food from the front of the mouth to the back of it. Begin

with soft foods that do not have to be chewed, such as oatmeal, applesauce,

puddings, scrambled eggs, etc. Some children tend to use a pushing action with

their tongue and will not readily accept foods. If this is the case, then help

him by placing the food midway back on his tongue at first.

4736-

37

Testing and Teaching - chewing: When teaching a child to chew, start with

semisolid foods like lumpy cottage cheese, mashed beans, and cooked carrots.

It may be necessary to work his jaws in an up and down direction in order to

get a chewing action started. Gently rubbing his guns may be necessary before

or after each bite is given. When the child is ready for chewing, then be

prepared to wait him out with each bite. Once the food is in his mouth, do

not let him spit it out. If he does, put it or another spoonful back in.

Because feeding him this way is slow, it may be necessary to give him smaller

and more frequent meals. The main things to remember is that you must not

demand less of him than he has already given. If he is hungry he will eat,

and if he is hungry aad the only thing he can get is something he has to

chew, then he will chew. Use milk and soft foods as a reinforcer only after

he has aewed some food. The first two days are hard on the child and the

parent or teacher, but experience has proven that this method works. Once

the child has learned to chew, then he is ready to take over the job of

learning to feed himself.

TestAm and Teaching - Indepenftt Bating: The child can now swallow, hold

food in his mouth and chew if necessary. To feed himself he needs to be able

to bring his haud to his mouth with fair control. To do this, have him seated

in an upright position with his head in a slightly downward position. His feet

should be resting on the floor or a foot rest. If the band to mouth movement

is not accurate then give him practice sticking his fingers in soft sweet sub-

stances such as pudding, icings, peanut butter, jelly, etc. If he has trouble

getting the fingers to his youth, then guide him at first. Suckers, bread and

chewy cookies that do not crumble can be used if he will hold food in his

fingers.

48

38

!Anger, Feeding: If the child can bring his fingers to his mouth he will be

ready for this first independent eating, finger feeding. Everychild goes

through this stage before he is ready to use a spoon. The first step in fin-

ger feeding is to get the child to eat the finger foods when they are placed

in his hand. Next is to get him to pick up the finger food and put it in his

mouth. Some finger foods may need to be broken into small pieces. Finally

he should be able to bite off a piece of the finger food, chew, and swallow it.

kinkin& from a glass: Now the child is ready to use something other than his

hands for the purpose of eating. Be usually begins using a glass before the

spoon, but there is no set pattern and they may be taught at the same time.

Be will first need to learn to drink from a glass while you hold it. Second,

he holds the glass with both hands, tilts it, and you return it uo the table.

Third, he holds the glass, tilts it, and returns it to the table with your

help. Fourth, he then learnt- to hold the glass, directs it to his mouth,

tilts it slightly, and returns it to the table by himself.

Some Usage: Onee the child is ready for spoon eating then finger feeding

becomes taboo. This is necessary if he is to move from one step to another.

Because of this f.t is suggested you break usual finger foods into small pieces

and have them eaten with a spoon. Once a child 1; learned to feed himself

with a spoon, then he can be taught that some foods are eaten with fingers

and some with a spoon.

When you begin teaching the child to use the spoon, it is helpful if you

can choose foods that will aft& to the spoon. Mashed potatoes, mashed ba-.

nanas, and thick custards are good starters.

To teach a child to feed himself with a spoon begin by filling the spoon

for him, then wrapping his fingers around the spoon with your hand on top of

his. Standing in badk of him, help him Able it to his mouth and help him

4.9

39

put a spoonful in his mouth. Then begin to gradually fade your assistance.

First begin removing your hand to his wrist, then to his arm until he will do

the act alone. Remove your hand completely when the spoon reaches his lips.

After the child can take the filled spoon from the plate to his mouth

without help, then teach him to load the spoon. For the blind child, the

fingers of his other hand will be his pusher. Teach him to bring both hands

to the plate, one grasping the spoon, the othur pushing food onto the spoon.

When he is more able to use the fork, knife and spoon, the spoon, knife, or

a piece of bread can be used as pushers.

If at any time during the process of learning to use a spoon, the child

begins to grab the food, throw a tantrum or show some other form of trouble-

some behavior, remove the food until he has stopped. If it continues, then

he should be taken from the table and not allowed to finish his meal. Be will

soon realize this behavior will deny him food. Do not give him anything to

eat until it is the usual time for another meal.

Fork ,Usage: The process of learning to use a fork is similar to the spoon.

The child will begin to use a fort in the same way that he uses a spoon.

Later he will learn that there are certain foods that are easier to eat with

a fork and require the use of the tines for piercing. The child should not

be rushed into fork usage. Many children feed themselves for a considerable

period of time with a spoon before moving to a fork.

Knife Usage: Begin by teaching the child to spread things with a knife such

as butter, peanut butter or mayonnaise. After he has learned to spread,

vaduaIly teach him to cut meat by asing his knife as a cutter and his fork

as a holder.

Manners: Through using good manners while feeding the child and teaching him

to feed himself, the child will acquire some manners. Re can be easily taught

50

40

to use a napkin< If he appears to stuff himself simply hold his food back.

Many children will eat entirely too slow at first, but as they acquire the

ability they will pick up speed.

Cafeteria Service: Because many childrea are in various types of institutions,

it is necessary for them to learn to use a cafeteria. Bach cafeteria will dif-

fer in lay-out and serving procedure. The followidg is included as an example'

of how the process can be taught.

First, the heleer takes a position behind the child, placing his hands on

top of the child's. They pick up a tray from the stack of trays. The tray is

placed on the ledge and the helper demonstrates to the child how the tray can

slide along the ledge. The child picks up his napkin and silverware that is

next. Deionstrate to the child how he can feel for his plate, grasp his plate

with both hands, ahd direct the plate to his tray. Slide the tray to the next

item. Direct htm to pick up all the items he needs. When the tray is complete,

direct his hands to feel the end of the ledge and let him know that it is the

end of the line. Place the child's hand under the sides of the tray. Have

him grasp the tray. Carefully and slowly have the child lift the tray from

the ledge, holding the tray parallel and in a comfortable position." Walk

the child to his place having him feel for the table. Re should learn to slidt!

his tray onto the table from the edge so he does not spill his food. Once the

tray is on the table, he should get into his seat. The helper should tell the

child what food is on the tray and where it is located on the plate. If the

child knows the position of the hands Oft a clock, it can be told by saying,

"The peas are at three o'clock." Otherwise the child's hand can be held light-

ly over the food and directed. "Here are the.peas, here's the meat, here'g

the potatoes."

51

CLOTHING

1,

2.

3.

4.

5.Cu 6.

7.

s.

14.

15.

16.

ewo.e

HESELP LP DEVELOPMENT

DRESSING SKILLS .

.

REMOVAL - The child:

Takes off socks wten they've been pulled.off over the heel

4.1 C.) Z 60 G Z =eel tri il 4.1 el TO .13 W

N 34 TO C3 C3 C3

P10 - UV TO NM CO TOM4 II 'el G .13 0 W e Wo 04.-locom u Ps."-, 0 .4 Ps 34 f .i 34 II 34

4.1 .0 400 =1-10 0 00 CO 0

ms w 4.1 M 1:1 ol tJol ilve4 SCOMM N'AM OM

11:11 tro t11:7411.:11tAtr:ilt w.riomeow 04141 0 4 0 0 0 0 Za C3 0.1)Z00.=ZO..0:C>C3

L

0 0TY) OGI04 .W . r40'V CA a0$40044 0 0 u

I-1 6 0214 B.0 0 .0 064$44.10

.

Takes off &mks inde endentl

Takes.off'hataffLuizi------,---Unsnaps snaps .

Takes off shoes wten untied an0. loosened . . MITakes off shoes wten untied

.. IIIIIIIIIIIIIIIIMITakes off shoes indemiently

hills one arm out of coat or shirt wten unfastened

Ptigs two Emus out of coat or shirt when unfastened

Opens zipper and takes off coat

Takes off pants if they're pushed down to knees

11111110.e s zipper and takes off .ants.

Unties bow Sno knots

Unties bow and half knot beneath ...... -.-.._..----.......----------Takes off skirt b ste..in: out of it when unfastened

is)

17.

18.

19.

20.

21.

22.

CFI 23.

24.

liAT AND

25.

26.

97,

28.

29.

30.

31.

32.

-.--- .---.-...--.1 - ---. ;r./........

454 :cr.?'

31.4P.. 0 04

.0 .0 r-4

.1# 61 40.00 4,1 14 r-4"omoor-1 > 0r4 ta, 43

VA'S CCi

............-ivi-.-0.-.-,...----

.-I E 1.,??120 Ur40 '0 carl 0 4.)P.. 14.00004 U

m1-4tO 03 CO.0 r0 .0re4 tIVllItiltlitIS

--4,-----

Uto 0 coZ 4.1

I.-I 14 04Cr-100 Of

c.) r-1tO *A 03f0 03 .0 CVO

-,--44U

CD ca4,1

)-1COor..1

tO CO

.0

11 V=0 0 C014 4,1 eri

OW00v4otou_- 4J 0i-4 a 0%I 0 tO 0till r

...- - - .DRESSIEG SKILLS (cont.)

Utkes off skirt b .ullin_ av,r head

Takes off over the head clothin:. .

Takes off boots

Unbnckles shoes

Unbuckles belt.

Unbuttons large bu tons

.

Unbuttons nadium buttons.

Unbuttons small buttons .

*tor - The child:

t

Puts hat or caa_m_kad.

YIELLIAL21E!aE2.4.12T.PSEPTLIttlY

i

.

snaps on ca.. 1

Disgaiuishes back of coat from front .

Nishes one arm throuh coat sleeve

Holds coat so second sleeve moves into_position

Pushes arm through second coat sleeve

aPulls coat u. on shoulders

33.

34',

35.

36.

37.

38.

39.

40.

41.

42.

SHIRT -

43.

44.

45.

46.

47.

48.

49.

-.a. .....aaaw---,--

..

DRESS/NG SKILLS (cont.)

... .

.

'tills ne_414222E.ALIIIS_912.21111-11MA been made

oi4 63W CIeel 444

M $44p.,00.0.0mpm .4 oi0 04 li W.0

ti.) JaOw$4 1-1NIWOmrI SSA > 4i,I 0 NI 0mooccealowww.oweww*

.44.Of0

oi WM 0 44er4 0 43in (I3P' I.eitu0

154 c)0 1-1

4' 4 .2 t 3 .r1 $4 r4

W oi4 V MW30 04.4 CO W0mum

0 Wt)

P-4 $4401-100 M

1-1

in 14 .2 ca.P> $.4 1'4

oiOf0WummW

P1ri 140001-1

4 .841.) $44 0.)

a 1

041) 0

.04u o 4P. 4.1 4.4W,0 CO a0140WWwmU

.0 441 0rI ig M03 w in z441 0 14 Crow.on)64 $4 441 CO

jpiu1is lara,kuttons throggh if they've been started

Pushes km12a_gmEssh buttonhole

Spreads buttonhole to receive button

Gras's button with thumb on outside edge

Buttons large buttons independent's

Buttons medium buttons independentl.

Buttons small buttons inde.endentl

Insertei one side of zi..er into the other

Zi's coat closed

!he child

Pushes one arm througti sleeve when shirt is held

Pushes both arms throulh sleeves when shirt is held

Distinguishes back of shirt from front

Pulls T-shirt cier head

Pushes one arm throu:h sleeve

Aolds shirt so second sleeve moves into position

,

Pushes second arm through sleeve

Z.11

CJt

4=

50.

51.

52.

53.

54.

SHOES, S

55.

56.

57.

58,

59.

60.

61.

62.

63.

64.

65.

.

DRESSING SKILLS (cont.)

Pulls button shirt up on shoulders

«A M4J 0or4 .r4

$.67. 0 04A .= 1.40 04 e 1 0"1 03 «A

Q.)..00 .0 $4 e-I*0 0 0 03

V4t1(411Vt1173111ValtC.);Ze4130,.AZad>.AZ>0

00eI 4J

0 Um4u *0 03*A 0 4Jt a 0P., $44001:6 U

A T-I*r(3 4 2 &i

.4 *0 0 0361) 0 0 0

4.4 03 4JU Uta 0 0 03 0

0 4-J 4JP U PN1-t $4 mAv-10 AO0 03

U *10 vI

t 1 42 a .

t'S

1;)00 000 0 A0. 4J or40v m «gANG70m000

.0 .w A-4 g 0

4e.1

,) 0 «A 0Hi-84J0

LineszittasSnaps on front of clothing

Pulls T-shirt down aver chest......._.

Buttons shirt

)CKS AND BOOTS - The child:

Puts shoe laces through holes

Crosses laces and places through holes ....__.... p.

Laces shoes correctly, crossing and lacing each holer

Loosens shoe laces .

Puts foot into shoes

Pulls shoe laces tight ....

1

Forms an "x" with the lace ends

Puts one end of lace thro :h the " "

Pulls lace thro lh " " to form a half knot

Forms a loop with one of the laces

Makes a second loop around his thumbr

-10..r -

CY)

66.

67.

68.

69.

70.

71.

72.

73.

74.

75.

76.

77.

PANTS -

78.

79.

80.

81.

WWWwwwwwomorrmmorlomPT"Bie"----"-7--

.

DRESSING =ILLS (cont.)

..*

Pushes loop through to form second half of bow

.ar ..p

orl rl 'i(214P 0 04

.2 1 ,-1 %

.4, co .=040 .1.1 I-1 mi"0 0 0 M

..4

714 g 1 ki

.1.I0 0040 "M CCI

g 1 " ,

i-10 0040

0 ..4MMAI- "0 .0 00'0I SI ig 713

zAPI CO 4.1

00 0 MP% S "

0I i-10 P.4 00 M

C.) r'tM....10to XI COM

I .Gt 1-13 II

3

0CCI 03

P% "0-1 i-10 00

mlMM

XI

I 11; 8

.

Ci c

00 0 0as .1.1 ,ri0II to .M014M0.r1 0 CCI 0

43 .1.1 0w4 0 0

ORI 08 ...02 08E-I k 4.I to

Pulls bow tight

..

Buckles shoes

Places right foot into right shoe .

Puts toes into sock .

Holits sock with heel down allil

,thers s.ck u thumbs inside 1.11Pulls sock up to heel

11Pulls sock over heel

Pulls bsgts aver sholL

Pulls shoe heel down in boots

111.11:11611111.111Pulls boots on all the wa

!he child:

Holds ants in fronta_Amht side up

11111Puts one lgg_into pant 1.21________________

Pulls u. .ant lel so foot comes through .

Puts second log into.ant leg

82.

83.

84.

85,

MITTENS,

1;6.

tjl 87..

88.

89.

90.

91.

92.

93.

94.

95.

96.

. SCARF -

97.

10401, Mra..

.

DRESSING SKILLS (cont.)

Pulls up pant leg so both feet come through

.

. .

«C CU

94 44(13 14P*. 0 a.

.0 .4 w-t

.r, ai .00 S t ,..ix) a)a)lt

04 lar4 0 'V 4J4144 0 0 CCMOCKIZ60

1,4 30 0t.) fa 0r4 0 44PN W

1 t) '= r4

"irl 4 .2 0.0 .14 101'40 Z 0 CO

:

.

1,3:1 P,00 0 0

Z 4414

& ..iii. °0 44

" To' .2 Chefa0 '11114CO Na 03 ZCLI..ZZ

113.0"

0 0:41

g °r4.20 1.1 0

0.3 0.3 Zt..)

140 0,0 la00 0 0Ch 44 14a)

0 14 0 0s4 0 0 CI..... 0 00 0 143 Z44 0 44 tr0 0 ..0 0E-11.44)10

_1.11P1.11_21BLIJIE-Tilis.-2E-LE.

3-12.3P2Ets.I

Fastens hook -

GLOVES AND BELTS -. The child:

Pulls on one mitten

.

1111111111111111111111111111

.

Places thumb in thumb of mitten

Pulls *on second mitten4

Places thumb in thumb of mitten

Pulls on gloves

.

.

.

Pulls gloves on right side up

Puts thumb in glove thumb

Puts fingers in glove fingers .

Pulls belt through belt buckle

Puts to :ue of buckle in hole of belt

P4P3 end of belt in belt loop

he child: .

Puts scarf around neck_......

4....b.. e

4=b

DRESSING SKILLS (cont.)

98.

Forms'an "x" with the scarfends

99.

Puts one end of scarf throu h the " "

SELECT/ON - the child:

100.

Chegall..lialliag-#49.DEARE-t2.221111Pre. ,

la

-TEACHING DRESSING BEHAVIOR

Testing and Teaching-- Buttoning Buttons

Buttoning buttons requires good coordination on the part of the child.

The task requires that he pull the two pieces of cloth together, grasp the

button between the thumb and forefinger of one hand and spread the button-I!

hole with the thumb of the other hand, insert one edge of the button into

the buttonhole, and push the button through with his thumb while pulling

through from the other side with the thumb and forefinger of his other hand,

then pulling the cloth with the buttonhole so that the button slides through

the hole.

Put a shirt on the child and button all but the middle button. Tell

the child "Button the button," and observeyhst he does.

Begin this activity from the beginning rather than the end. Teach hi=

to gulp the button between the thumb and forefinger of his right hand, With

his thumb'under the outside edge of the button. The edge of the other side

of his shirt is held between the thumb and 'forefinger of his left hand,

with his forefinger on the inside of the shirt and his thumb spreading the

buttonhole open. Show him how to push one side of-the button through the

buttonhole, at the same time moving the forefinger of this left hand around

tograsp the button as it comes throUgh. Next he must pull the button through

with his left hand thumb and forefinger and at the same time pull on the edge

of the shirt next to the buttonhole with the thumb and forefinger of his

right hand. Begin the buttoning practice with a shirt or coat that has very

large buttons.

When unbuttoning, reverse the process.

5948

TEACHING DRESSING BEHAVIOR

Testing and Teaching - Putfing on a Pullover Shirt

Putting on a pullover shirt includes determining which side is the back,

pulling it down over his head, putting one arm in the correct hole, putting

the second arm through the other hole, and pulling the shirt down in front

and back.

To evaluate the child's ability to put on a pullover shirt lee give him

a pullover shirt and tell him to "Put on your shift." Pay attention to the

kinds of errors that he makes because this will tell you what parts of the

activity have to be worked on the most.

When teaching this task begin from the "end" of the activity. To do

this begin by simply having the child pull the shirt down in front and back.

When the child can do this correctly and easily, remove one arm from its

hole and teach the child to replace it, and then pull it down as before.

Following this, remove one arm, then the other, and then pull the shirt

down. The next step is, of course, to teach him to pull the shirt aver

his head, then push one arm and then the other arm through the sleeves.

Finally, the child must locate the back of the shirt and then pro-

ceed through the rest of the activity.

When undressing, reverse the procedure.

60

49

TEACHING pans= BEHAVIOR

Testing and Tedching. Putting on Socks

Putting on socks can be a very difficult task for many children. It

requires that they learn to hold the sock correctly- -that is, that the heel-

side is down. They must also learn to hold the sock with the heel-side down

and with their thumbs inside the sock. Next they most learn to fold the sock

up into their hands, place it over their toes, and pull on the top so that

it goes over their foot and up their ankle.

Evaluate the child by giving hie a sock and telling him to "Put on your

sock." Watch for his errors so that you will know what parts of the activity

must be worked on the most.

In teaching the child to put on a sock, begin at the "end" of the ac-

tivity. Start by correctly folding the sock up, with the thumbs inside the

sock, placing it over his foot, pulling it over his heel, and simply hsving

him pull it up over his ankle when you tell him, "Pull your sock up." It

is best to do this while standing or sitting behind him, so that he sees

exactly what it should look like if he were doing it himself. When he can

putt it up easily and quickly upon command, put the sock on but only pull

it halfway On over his foot, having bin pull it over his heel and ankle.

NCxt require him to putt it when it is just pulled oVer his toes. liext

fold it up and give it to him, making him take it with both,thumbs inside

as it would be if he had folded it up himself. Then he utast put it over

his toes and pull it all the way on by himself. Next teach him to get it

correc tly in his hands, with his thumbs inside and with'the heel down.

Finally, teach him to perform the rolling activity--to fold the sock up

into his patms before putting it on over his toes.

50

61

51

Remember to require that on each try the child go through all the activ-

ities that he has already learned, and never save on to a nor 444ttvity until

all of the earlier ones are done easily and correctly.

When taking the sock off, reverse the process.

TEACHING DRESSING BEHAVIOR

Testing and Teaching - Putting on Pants

Putting on pants includes holding them so that the ftont of the pants

is in front of the child with the back of the pants next to him, putting

one leg into the pants leg and pulling them up so that the foot comes through,

doing this for the second leg, pulling them up over the hips, zipping or

buttoning the pants, and fastening the belt if one is provided.

We evaluate the child's ability by giving him a pair of pants and tell-

ing him to "Put on young pants." You should let the child try several times,

keeping track of 'what he does. Pay attention to the kinds of errors that

he makes because this will tell you what parts of the activity have to be

worked on the most.

With this activity we start from the "end". To do this we begin by put-

ting on the child's pants and leaving them down around his knees ( we will

ignore, for the moment, buttoning and zipping them). Then we teach him to

simply pull them up over his hips, giving rewards as necessary. Next we

remove one leg from the pants, and teach him to stand on one leg and put

the other one through the empty leg. Each time that he gets this leg cn

be sure to have him complete the activity by pulling them up over his hips.

When he can do this well we remove both legs but give him the pants in the

proper position; that is, with the front facing in the correct direction.

Finally, when he is able to put on both legs correctly, we have him the

pants in the wrong position and show him how to get fhem in the correct

position before trying to put them on.

53

Notice that on each try we always require that the child go through

all of the activities that he has already learned, and we never neve on

to a new activitY until he can do all of the earlier ones easily and

quickly.

When taking pants off, reverse the process.

64

-TEACHING DRESSING BEHAVIOR

'Testing and Teaching Tying Shoelaces

Tying shoelaces is one of the sore difficult tasks for many children.

/he child must be able to use his hands and fingers very smll before it

will be possible for him to tie his own laces.

The activity consists in pulling the laces tight, tying the first half-

knoto.looping one of the laces over the thumb, and pulling the other through

to fora the bow. A useful aid in teaching this activity is a shoe with two

different colored laces in it ummmted on.a board. This allows the child to

practice ulthout bending over, and lets him see more easily how the laces

go together.

Evaluation for this &cavity is very easy. . Simply put the child's shoe

on and leave the laces loose, telling hint to tie his shoe.'

Either the child's shoe or the one on a board mentioned above can be

used to teach this activity. /f the one on the board is used, place it in

front of the child'with the heel towards him, just as it would be if Ue had

it on. This will sake the training more like the actual activity that he

is learning.

This is another activity that is started from the beginning rather than

from the end. First, put his shoe on him and leave the loops long enough

so that he can easily get his fingers into them to pull them tight. Show

him how to pull on the loops to tighten the laces, and then have him pull

on them himself. Guide his hands gently if necessary. Be sure to reinforce

him for any behtvior that is in the right direction.

6554

55

After be has learned to pull the laces tight, teach hia to tie the first

balf-knot. Begin by showing himr how to form an "X" with the laces, and then

putting one of the ends under the "X", pulling it out and tight. Wire him

repeat this until he can do it easily by bismelf. /t is not necessary to

loosen the laces each time, but do this frequently enough to make sure that

be gets tbe idea that first he must pull the laces tight, then sake an "X",

and finally loop one end through and pull it tight.

Next show him how to form a loop with one of the ends. This is enough

for this step, so make him practice it until be can do it easily and quickly.

Then show him how to loop the other end around his thumb and push it through

the loop to form the other half of the bow, and.pull it tight. This is prob-

ably the hardest parts.but if be has been successful in the first eteps, be

will probably learn this quite quickly.

/f, howivcr, the child lacks the coordination to do this and fails to

learn the task, it may be necessary to teach him to make a bow by forming a

loop with each band, cross Chem into an "X", and pulling one loop through*

The loops should be treated as single laces if this is done.

86

LEVEL OF

L.

2.

3.

4.

TOILETIN

6.

7.

s.

9.

10.

11.

12.

13.

14.

15.

- ....= al

U) )4?+ 0 cu.0 = '4

0 0.0--1 WIn ca .0

'154$`4.174r.I 04 1J

m 0 co 4.

co

4.4

M t)o .0 cOpi G 4.4ti) RI?+ o

'I* .1* 0 0.

ias 130 ..0

Z *0 co

.r. C4 .1.)

N-1 t)co 0 RI

* .1-)N 0

r-t 14ze".4 0

0 r-+..rimT.) U) .0 0.0%)

Z ad P' I C

1 gi

4..)

t)RI RI

44P...

,--t 14G 00;-4coa.0

Z °P L)

.

c

Co 0 dCid :4 ,r4

14 ci, a6% lil) CI a1+4 M MM g .tr: p__

E1 14 .1.,) U)

, -

SELF HELP DEVELOPMENT

TOILETING SKILLS

FUNCTIONING - The child:

Can be "caught" bv, the teacher on a tine schedule.:

pan, bp-"caught" by the teacher through teacher's observa-tion of general physical signs of the child's needs

Can sit on the toilet with hel.

.Shows discomfort at soiled pants .

; - The child:

Locates and enters bathroom.

. .

,

.

Locates and shuts the door.

1111111111111

Locates the toilet

Pulls down Eints

Sits on toilet .

Eliminates in toilet

1-1=1c-tt-S2-2.41PMH---

Tea.rsofLpaper_________

Cleans self

Discards pazer 11111Stands u.

16,

17.

18,

19.

20.

21.

Cr)

(XI

22.

23.

TERMINO

24.

25.

...,.--.....-,..

....0 .---_,%

.1.c.)

, 0 :I. 0 0.

..0 =ri

0 04 ri 4)1W-PWC

2=

0 .I.J mri

'00 0 Ml'I >

Z0(0(0

r.IC

UJ.J

(4 0 G C

g0

00 .0 41.4 C

43W

(0:

in4 tjel ri"0 *0 .0 C

oW

Z 0 0 ra

;)ri 0 4J

4.1

00

W 0 03

M (1

Z .1./

4J:0'4 0

r"

gr.' 8

=8

"0 (010

0 14rl

WI.A

MW

M'0

CO

.0 Co

.04)-G

0 0 0 0Z

16 0

0 0 CC

. 4.) el0

w ..g

= m

w w

A000a

00 0 C

O Z

./..)a

riC

r0

0-G 4)

ria....001101...111.1411MO

MeN

wor

TOILETING SKILLS

Pulls up pants

c nt.)

i

I1122-2.121E-11L--

Re-arrinles clothinl

_

pcates handle

.

---..........

-...........

----........

Flushes toilet

Locates sink

-

Washes hands

....

,

,

4

Leaves bathroom

G?

-The child:

pees proper term

,

v

Reads and understands signs:

-

11.a.

Bo

s

b.

Girls

1

c.

Toilet

111111111111111

----"'""r--d.

Rest R

oom1111111111111111

e.

Washroom

1111111111111111

,

f.

Men

.

-

-

RS

6 9

, ,

rs.

s..."

,.

I.

Will do job witcomplete physicand verbal ortactual helpNeeds physicaguidance andverbal or tactu

helNeeds only s igphysical cue anverbal or tactuhelpNeeds on y averbal or tactucue

-1

P

Total independeremembers to dcthis task in

sequence

--

--

_--

--

---

---

- -4

IN'II

MIN

IM! 1

1111

1M

N II

MM

IIIIII

IIIIII

IIIIII

IIIM

IIIIII

MM

EN

IMIII

I 111

111

MIII

IIIIII

IIIIM

M I

1111

1111

1111

1111

1111

111

III01

1111

1111

1111

1101

1111

HIP

II11

11 1

1111

111

1111

1111

111

1111

1111

1111

1111

1111

1111

111

1111

1

IIIIII

IIIIII

IIIIII

IIIIM

MIII

I111

1111

1111

1111

1111

1111

1111

1111

1111

111b

1111

1111

1M1

1111

1111

1111

1111

1111

1111

1111

111M

III

0111

11

III 1

1111

11N

IUM

EN

IMIII

IIIIII

IIMIII

1111

1111

1 M

IIII

IIIIII

IIMIN

IIIIII

IIIIII

IIII

IIIII

IIMIII

IIIII

III

II III

IIIIII

IIIIII

IIIIII

IIIIII

II11

1111

1111

111I

IIIIII

IIIIII

111

111

'

1101

1 1

1111

1111

III 1

1111

1111

1111

1

t

Mill

iiim

Nil

"IIII

I 111

11 I

"111

1111

611

"0"1

1111

1111

0111

1111

1111

111

,1!

r1111 1111 III 1111 1111111 1 1IIIIIIII1_ 111 11 111

1111111111 11 1 1111111111 II 1111111111111 1111

1111111111 11 1111111111111111111111 11101111011111111111111 1 11 111111111 iiiiiiiiiiii IMM1111111111111.0 II 1 1 111111111 Milli 111111111 III11111 11111111 111 1 11111 11111111111111 1111

11111 111111111 1 ii I 0011111111111111111111111111111

111111111111111 1 111 1 111111111 111 III IIIIIIIIII

111 111111111111111 1 1 1 1111111 1 11 111111111111111

1111111111111111 Mill I IIIIiIIIIIIIIIIIIIIIII 1111

1 II1IIIII1IIIIIIII1I1II 111111

111111111 1111111111 1111111 1

!Hi I! IR 111ci!

II0

"s

.11

sr*O41P4.N

I 5: n5 i

I

1

1

I......_. eMINA lia-........-......

eI. I

..........,,...

1 .. 1

2...z.....t ) 51

...

1 ---.,

.

IL_____,_____L___

1i 5: V5: 25 i I I

5: 305: 35 I .

1......____ _5: 45 1 T5:50 I t

E. 1

-

# 5: 55I

__________605 ;

6:10 1

____-1_

. i I

. 6: 157.,:20

1 I

I I

6:2D I . I .

6: 301

i I

r 6.35. ._.--

p 6.40 I)

6:456: 50

i S: 551

1

1

_

7:007: 05

I 7: 1G. 7: 15

I 1

1.

,

1

1111111111111720 t

i -I: 2, I 1f" .. 1t 7: 30 I I

_..

I.t -I : 3,i 7: 40

14..___I I

I I121454 7.50t.---s

1

_

I I.

IIV755 _____

8:00 i I

05 1

. 8: 1SIi 8.20 Ii--*-----c 8:-25

____

='.IIII i

,i. 8:40 i12:: 45f 8: 501 P: 55

I III:11111111--I

I

I _

1111.111111111111=157.I

iI_

t 9: 00 I i_05i ;f._ ___ _:_. 1E111 I

..3

1 i ;

; 9: 20 =

rEi5.1:::=1-----1$ 9: 30

1I

i, It

,

,.IIIIi L

:1

4.....o . i.....1 -

. --......._10: 00 : II.. ÷ ....,..........t..........

I I:I 0: 05 I-_-- ----t--_:I 0 : i 0 i

*

i_ ' --.1.-.1--

1------t------7I t29 1------.it

-...2-1-

i

1 I

---i

:i

i,..... .....1...111m 6 1 .

5,it;

111-

1-:

-

II11

1111

1W

M IM

MIH

NIM

MIN

IMIN

INIM

MII

1111

11II

1111

IM1H

ININ

IIMM

INE

M00

1111

NO

N I

II IH

ME

NIM

ME

NIII

IINIM

MIN

IM

I 11

1111

1111

1

1111

111

1 11

111

INN

IIIM

MI

11 1

1111

1111

1

1111

111

1111

111

0111

IIIIM

IIMI

IlIlIn

looh

lIN

IIIM

ME

N 1

111

I1

01 II

HIII

IIIIN

IIIIIH

IUI

MIM

E IN

NIM

M11

1111

M11

1111

1110

1111

1110

111N

111

1111

1III

IHIII

IUH

IHII

0111

1111

1111

111

1111

011

1111

11

1111

111

1111

1I 1

1111

1101

IIIII

IIIIH

IIIIII

IIHIO

IIOIII

1111

1111

1111

1111

IUIIIIIHIIIIIIIIHIIIIIHIIIIUIIIIIIIIIHI

lIHflh

IulIl

lIIuu

uIIIH

hIuI

uuIII

IIIIII

IIIIlI

uII 1

1000

MN

HIM

IMM

I IIII

IHIU

IIIIII

IIIIII

I1IH

IHIII

IIIII

1111

11

:oN

o

S.

4:oN

o

S.

; I;U

IS

. UI

vit

;S

. "v8

,;;S

. v2.

;S

. ,0S

. ,0; ;

IMM

INIM

MA

IMIIM

MIN

IN I

I11

1111

1111

1111

1111

1111

1111

1111

1111

111

IIIM

IIIIM

I IIII

MIN

IIIIII

NIN

ME

I 111

1111

111

1111

1 N

H 1

1111

1111

11[

NM

111

0111

1 11

1111

111

1111

1111

1111

II1

1111

MIM

INIII

IMM

ININ

INII

111

iM11

1 11

1111

1011

1111

1111

1111

1111

11M

INIM

IIM

MIN

IMM

I In

101

1111

1111

1111

1111

1111

111

1111

1 11

1111

1111

1

IIIM

MIN

IHM

1111

1111

1111

1151

NM

I11

111

1111

1111

1111

1111

1111

1111

MM

INIM

INI

1111

111

0111

1111

NIM

MIM

IPM

1111

1111

0111

111

IMM

IIIH

M11

111

111

S. UI

TOILET TRAINING

Obiective: In toilet training the child should become completely independent

in caring for his own toilet needs. Toilet training is a task that requires

separate skills that the child must view as one continuous act. This contin-

uous act begins with the feelings the child has when he needs to use the

toilet and ends with washing and drying his hands when the 'task is done. The

separate skills required for the multiple handicapped child include locating

the bathroom, lacating the toilet, pulling down his clothing, sitting on the

toilet, eliminating, locating toilet paper, cleaning himself, standing up,

pulling up and fastening his clothes, finding the toilet handle, flushing the

toilet, locating the sink, washing his hands, and leaving the bathroom.

Testing and Teschiniv To teach toilet training, begin'by keeping a record

sheet pinpointing the exact time when all bowel movements and urination occur.

Keep this frc three or four days around the clock. This chart will show when

elimination is most likely to occur. When this is known training can begin.

Start with bowel control at times when this behavior is most likely to occur.

Take the child to the bathroom at this time. Help him find the toilet. Aid

him in pushing down his pants. Seat him on the toilet. Keep him seated on

the toilet for at least five minmtes, but gradually demand longer periods of

time if necessary. If he tries to get up he should be held firmly until he

stops struggling. If he does not try to get up for a few seconds, gradually

release your hold from him. The child should never be allowed to get up un-

less he is sitting quietly.

If the child does eliminate show your pleasure and continue your teaching.

Direct him in finding the toilet paper, rolling off a portion, tearing it and

felding it in his hand: Ihen direct hie to clean himself. Teaching the child

65

to clean himself properly sod thoroughly is difficult. Guida. his hand as he

performs the act. He needs to experience the feelings that "come from proper

cleaning. It is particularly important for girls to be taught to clian.them-

selves properly in order to avoid spreading germs from the anus to the vagina.

Guide her in cleaning in a front to backl never forward, memement. After

urination have her use the toilet tissuelis a blotter. After the child has

cleaned himself direct him to discard the paper in the toilet. Next help him

stand and pull up his pants. Help him locate the toilet handle and flush the

toilet. Now he must be guided to the sink and taught to wash his hands accord-

ing to the procedure outlined for hand washing. When this is complete, he

leaves the bathroom.

If the child fails to eliminate iiirect him to stP.nd up and pull up his

pants. Guide him to the sink and have him wash his hands before he leaves

the bathroom.

With each successful step praise the child in a way he understands. Do

not punish failures, but do not reward them.

It is highly unlikely that sequential order will be used in acquiring .

this skiLl. A child may first learn to flush the toilet, or pull down his

pants. For this reason the measurement of his ability is needed on each

step of the skill.

78

. 0.

WASHING

READINES

1.

2.

HANDS-

3.

4.

5.

6.

7.

84

9.

10,

11,

12.

13,

ea,

--- ......_

SELF HELP DEVELOPMENT

GROOMING SKILLS

..

.

; - The child:»

Shows interest in playing in the water; permits hands to_be washed and dried

r-I ritO }4?..0 ..

.0 .0 r-t0 0....14)M0'In 0 ..0

W.o 4.1 34 t-40 031 4) 4)r..1 ZCOMOte:- I. 4 i n:1 tril).rt cowzow04wwwwz

tPt 4403 00'009'4 0 41?.. }4«COO0.1 C.)Z i-1

:14 44 .. 1

-

r4 Kti 44t-t 0tO 4)0

0 4-1PN C.)

r-t }4I4O0 rdC.) r"4tO er10

.1?) lil 19 it

.

.1.)000.1.)

PN11 3-1GO0

r.4WO71 44 4)

0 "0C0 0 CQ. 44 -10to 04 XG )4 tO 4)44000r-I 0 02143g.04)..c w

.

Shows interest in faucet and stopper .

ale child: .

.

Locates sink

.

.

..

Locates faucet :.!.

.

Turns water on

.

Wets one hand

Wets both hands

Locates soap

Gets soap on hands

Rubs sba. on hands

.......

Rinses hands

Locates faucet.

Turns water off 1

Z

dig

17.

18.

FACE:- T

4ftsi

19.

20.-

21.

22.

23.

24.

25.

26.

27.

28.

.........___p-

GROOMING SKILLS (cont.)

.

Locates towel

.

,e4 -1vac:by.'-

PN 0

j2 4o4

o o..-lomm

co ..0v .._,

000.1M9..1 p.Z

0M0

iI Oe

4.107.0m

0 co 4 J

wI

1J0

004t)

'0 0,r4 0 .6a>

,w

4000.-1

z

a) o ze-I 0 4./00 0 C

O.,

t.9 "

-- ii.1

0.-100 -1

4) 440V

tada 0474.:1'

t 74

4.10011

CO

4.1

iI Ya

000sI

MM

3))'al 1

w u

'0 *"000 0 0

/1:14 1.3

9.4W1 II ig wri W

M 0

iI 00

ta era' 47

Takes towel

..

Dries hands

Locates waste basket

.

01.1..

Throws towel awa

or han:s it u.

.

mechild:,

.

Turns on hot and cold faucets for warm water

.

.

.

Washes his hands at the a..ro.riate times

indeiendenti

Gets waihcloth wet

.

!Wtos soap on cloth

.

Washes face (not ears)

.

.

Rinses cloth

.

Rinses face

jaws cloth arui

Rubs face dry

lagleAJELEJLLatatmEllitEglem...

-........

89

0rt

Will do job withcomplete physicaand verbal ortactual helpNeeds physicalguidance andverbal or tactuahelp

Needs onlyWrikphysical cue andverbal or tactua'

helpNeeds only averbal or tactual.

cue

Total independen'remembers to do

this task insequence

WASHING HANDS

t.

Task Definition: Washing hands is a task which requires several skills per-

formed in a sequential order. It requires the multi-handicapped child to

locate the sink, then the faucet, turn it on, get the soap, rub his hands,

rinse them, turn off the faucet, get a towel, dry his hands and discard or

hang up the towel as the case may be.

Testing and Teaching: To evaluate the child's ability, ww..tell him to "wash

your hands." If he cannot hear you then indicate in some way what it is that

we want him to do. As he tries, keep track on the check list of how much

help he needs. Thi: check list becomes the teaching guide.

In teaching this activity start from the beginning. Identify the sink

as the place where hand washing occurs. He is taught the feel of the faucet

handle and is helped to turn it "on". If blind, he then follows his hand down

the faucet to locate the water. Next he must put both hands in the water to

wet them. Then he must locate the soap bar, pick it up, rub it in his hands,

replace it and continue to rub his hands under the water. He must then

rinse his hands, find the faucet, turn off the water, locate and get a

towel, then crush it and discard it in the trash can, or hand it on the

bar as the case may be.

It is quite possible that a child will be able to perform only one

isolated part in the complicated process. It is most important that he

always be allowed to perform that one task when it appears. For example,

if all the child.can do is pull the towel from the container, then by all

means always have him do it. At the same time, he receives physical cues

with the other parts of the task and then cues are gradually faded until

he can complete the task independently.

69

HAIR

T

I.

2.

3.

4.

01

5.

C)

6.

7.

8.

9.

SETTING

10.

11.

,-.-.

0.-(1....N

IIR-

.4

...

.

GROOMING SKILLS (cont.)

le child:

Uses comb and brush on others

4Jt)

eel v.)1.4

P, o 044 X

v..)0 cu.-1003a

orlIC

Xo .o

0 4114 r-4

msw

om1.....Z

WR

IMI-i

a.43

Vig1"431SitItProl'ItS

I:tom 4.3

Zr.4

4.10

00 T

S AI

tr.1Pa

.1..b

?*14

= 00

04 0cp-fO

"0 .0 06"0

Z 00

X

..

bOG

4.4 0 4.)m

40

V) 0 0Z

14p, 0

1-114

Gv-10

0 CUor.#

t.0v.IMV

) 4 -

Z 04

.e

Z4.10

10V

ii.b

>.

%..4

14G

Oo

r4W

M"0 X

zo

0 0'0 '0a0 0 Gtu, .1.4

.o..1

0roco a

G 14

V) 0

v400042

v...1 E0

Cti

C.)

{A z

tal:guE

-ii.4

4.1to

Admires own hair when well Broome

Removes barrette from hair

Brushes hair

Combs hair

or brushes

down on sides

P.

Combs hair down in back

Replaces clips

barrettes

.

Cleans Comb with brush

Combs or brushes hair at Appropriate times

MD SHAMPOOING - The child:

,

Sets or rolls her own hair

Washes her own hair

-....-

-

6.81:71nrmrolm

ismolm

irmom

na

ior.

..16**MO

INIY

1.MW

BRUSHING

READINES

I.

2.

TOOTHBRU

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

IMP

K--t .

.

GROOMING SKILLS (cont.)

.

.

TEETH

1 - The child:a.

Shows interest in brushing teeth or owning a tooth brush

41 (.)e4 er t)cok

PN 0 m.0 ..0 1-4o cut-i 0rn CO .00.00 4-3 34 3-4'0 0 4) 0

wi 0:741 tv 4444 0 z to

L 20 00 i.c) CO...1 C 4.1CO 0 k.0000. 0

0 r..1CO 0 0

71 1.) 74 f4 r911)0 0 0 0

-

3:3 1 Br4 0to 11,1 (13Z asPN 0.1 ).40 3-100 0

0 ro.It.044 0CA 5. 1:00 .0 4) 0

ZAi00 044

P13-4 I.10 00 r4tb 03

1 'Pi 00 0 0

W U"0 ro00 0 0c... ..1 .ri01 4 .41 4)r4 0 il 0

...* 4-) Ce-1 a si

2 1 .2 g-0 0 .0 0E4 14 43 ta

Plays at brushing teeth.

IHING - The.child:

Locates sink

Gets his tooth paste,

Takes cap off paste .._

Gets his brush .

Puts oaste on bristles

Puts brush into mouth

Brushes teeth front back u . down

....

allp .aste out

Turns water on -

.G..3-,aP1

Gets water in cup .

Rinses mouth and s.its

15.

16.

17.

18.

19.

20.

21.

22.

23.

GROOMING SKILLS (cont.)

.

Rinses brush

.'

ri44

43oom

co

uo..oc..uvco

11 A 0 43

61"o 4.1-4

0 V)

CU

CO

1..0

(1).000

°004)03all

1"40 C

O01

CO

..4 O.

4SM

I .0.

71,1 8 '2 cl S'6".4 %

41C

O 4su

wow0 13k

0..404) .4

VI erl

CO

V C

O 4

aI I' tt V

)

utvcot

r M0001.4

CO

CO

V A

It S.

'2 "-?

g o m

CU

43 1/440'0014(1)0er4(1)014)

.0 43 0P

.4 00

CO

W 01 Z

46'tt .1.171 V

Turns off water

Returns brush to proper place

w

Puts cap on paste

Returns .aste to .1ace

Locates towel

..

Mil

11111111

.

Wi es mouth

4

Wies hands on towel

1

.

,

Brushes teeth at,appropriate times

AnrallrinISIM

rlww

wA

llaININ

NIN

Imm

osnomarril=

rdmm

aim.

BRUSHING MTN

Definitions Bruihing teeth, like washing hands;-is a task which requires

several skills performed in a sequential order. It requires the nulti-handicapped

child to locate the sink, the toothpaste, move the cap from the paste, locate

the brush, brush his teeth, turn on the water, git his cup, rinse his mouth and

the brush, turn ofg tha faucet and replace the cap and retUrn the paste and

brush to its proper place. He must finish the act by finding a towel and dry-

ing his hands and mouth, and replaos the towel or discard it as the case nay

be.

Usti% and Teaching: To evaluate the child's ability, tell him to "brush

your teeth." As he tries, keep track op the check list of What he does, not-

ing the kirds of errors he makes because they will show what parts of the

skill the child has not developed. If the child is unable to do the task,

Of any part of it, give him as much physical help as he needs, but carefully

record the steps in which he needed help, and how much help was needed. Re-

member that the child is to perfora all segments independently if ha can.

The check list becomes the teaching guide. It will tell uhere to begin to

teach each segment of the skill.

84

MISCEL

NOSE

1.

2.

3.

4.

5.6.

7.

8.

NAIL

1.

2.

3.

4.

5.

6.

GROOMING

SKILLS

(coni.)

.

&MOUS

Z -

The

child:

;

Allows'

nose

to be

wiped

when

necessary.

4.1 Q

el ,r4

0 3-1

P10

.a

.4.

r.4

0 II.,-

1 0

In AI

.C:

0 Btl.

'474

.4t

'0 0) 0 0

1 *

"I I. '0 44"ivi OM

OZ

O0

-m)

0 CO Z 0 Z

4.4 r4 0 4J 4J

0 0 0 0

0'00

04)0

3

043

10.1

.1

44 CO >1 0"

p.,

.P;$ 14 I.°

g7I0 ° 8 °

0 r.4 0 1 -1 r4f co ct

s to o ..4 co to CO

11)

rS 4.1.

1

,!!' i 'At

,-4 1 f4 4)

..G00

00Z

14) 0

C0 0 0

0r4 0 0 9.0 44 ,a

.i

r-I i 4)

CO 14 Z

4.4 e *rt

Cr

E.-1

w 4.1

ta

.

Wi.es

nose

with

assistance

'

1.1.1

Blows

nose

with

assistance

Blows

andwipes

nose

when

reminded

Covers

nose

when

sneezin:

.

Covers

mouth

when

cou:hi

: . .

Blows

iose

when

appropriate

.

Cares

for

used

tissues

3 -

The

child:

Allows

nails

to

be

cared

for

.

Admires

well

groomed

nails

,

Attem.ts

to

clean

his

own

nails.

.....,.L.___..-...--___..

Asks

for

help

in

filing

or

cuttinf

nails

Cares

for

own

nails

Attempts

to

apply

polish

(girls)

CARE OF

1.

00Cr3

2.

3.

4.

5.

6.

7 .

8.

9.

10.

,

r431.4

P't 0 040-4 440 00'4 4)

0 1-1 )4 104V 41 4) COr4 P. Z4.4 CU .1.1 P0

.11

0.41

M UU .10 CO

0 441ti3 0

04 U0 r4til 41 CI

'V .0

.

44\....1

04 PO

03

U3 4)Z

ON U

r40 CO

Uti3 sr!0

14iUCO

4-1

0r4040 0412

1.1U

CO 01.7

P'tr40 00

r40 3 0

40

ci:

PC1 ea00 0 004 1-1 ..e40

ro1 4) OS U

r4 ja " g6134 I

1ito

GROOMING SKILLS (cont.)

,

ELONGINGS - The child:

on hooklianas coat, smock. etc..'.

for own things.

-..

.

Goes to proper place

on hooksHangs towel and washcloth

from proper placeGets own *rooming supplies

..Puts hats or scarves in proper place

Han:s co t o ha ler

before coming inRemoves boots

before coming in .Wipes muddy shoes

. --Shines shoes with assistance

._ .___ LA- c.-1..........J........ 4mAaehamotantim.11.W.SVhbrgosAmawma

YOTOR PROGRAM (FRAMEWORK)

I. General Mbtor Development

A. Balance and Posture

Through the activities of balance and posture the child

determines where the line of gravity is and the direc-

tion of its force. He is also able to develop a point

of origin for the relationships in the environment around

him.

Activities to develop balance and posture include:

a. on stomach

b. on back

c. sitting

1. on floor

2. on chair

d. standing

1. on wooden blocks

a. arm movements

b. trunk movements

2. balance beam activities

B. Locomotion Skills

locomotion includes these activities which result in

moving the body through space. With these activities

the child investigates the relationships between objects

in space.

76

87

77

Locomotion skills include:

a. crawling

b. creeping

c. walking

d. running

e. jumping

f. hopping

g. leaping

h. climbing

i. rolling

C. COntact and Manipulation

Includes skills of manipulation by which the child handles

objects and explores their nature. Contact skills usually

involve the hand.

Contact and Manipulation skills include:

a. reaching - process by which contact is made withan object

b. grasp:ng - contact in maintained while the manipu-latory activities are completed.

c. release - contact is broken

d. eye-hand coordination

e. foot-eye coordination

D. Receipt and Propulsion

Receipt includes those activities in which the child

must relate to an object moving toward him. The child

places his body in the path of the movement, as in

catching and stopping. Propulsion includes those

78

activities in which the child must relate to objects

moving away from him as in pushing, throwing, and

batting.

Progressive bal I handling skills include:

a. catching

b. throwing

1. overhand

2. underhand

c. striking

1. kicking

2. batting.

II. Movement Exploration

A. Body Image

The complete awareness of one's own body and its possi-

bilities of movement and performance

Identification of body parts:

a. head

1. ears

2. eyes

3. nose

4. mouth

a. lips

b. teeth

c. tongue

5. cheeks

6. chin

7. forehead

79

b. Arm

I. fingers

2. hand

3. wrists

4. elbows

5. armpit

C. Legs

1. thighs

2. knees

3. shin

4. ankles

5. feet

6. heals

7. arches

8. toes

d. Trunk

1. chest

2. stomach

3. waist

B. Laterality

Can be characterized as an internal awareness of the.

similarities and differences between the two sides of

the body.

90

80

a. Right and Lail.

b. Up and Uown

c. Front and Back

C. Endurance

91

t

COMMUNICATION

Names are shown by placement of the first letter of the nameon some body part eg. "g" on chin, "h" on shoulder. Twochildren with the same name would not have the same sign.

eat / food

out

6ind

81

finished

on

up

b

4

,

.,1:6;,!7%,.

, open

-

82

close whati

s'

- where(at waist level)

go

:-

water

ft.....1.,"".ii

83

\ % ----->

wash

gooa (emphasize the hands together part)

,

,

94big

-

toilet("t" - rotate forearm)

I ittie

1

4-i

1

i

i

more

1

tree

catmake whiskers)

84

break / broken

-

fly / airplane

..

95

iLTi

i1;

85

ball

yellow("y" - rotate forearm)

blue "b" and n3tate forearmpurple "p" and rotate forearmorange "o" and rotate forearm

11 1111 0I

00

(Use fingerspel l ing for "hi".

red

(straight down to chin)

96

boat

green- rotate

forearm)

BODY PARTS

Simply point to parts of tnebody. For example, for "mouth"point to the mouth, etc. Forhands, touch the back of eachhand.

BIBLIOGRAPHY

MUltiple Handicaps

Barraga, N. Increased visual behavior in low vision children. New York:

American Foundition for the Blind, 1964.

Barry, H. The young aphasic child. Washington, D. C.: Alexander GrahamBell Association for the Deaf, Inc., 1961.

Bensberg, G. J. Teadling the mentally retarded. Atlanta: SouthernRegionai Education-Board, 1965.

Bluhm, D. L. Teaching the netarded visually handicapped. Philadelphia:W. B. Saunders Company, 1968.

Cooper, Louis. uThe child with rubelle syndrome" in The blind child whofunctions on a retarded level: se!ected papers .-`WYork: AmericanJ!oundaflon for the Blind, 1970.

Cruickshank, William M. Cerebral palsy. Syracuse: Syracuse UniversityPress, 1966.

C.Artis, Scott. "Speech and language evaluation" in Deaf-blind children:a program for evaluating their iilultiple handicaps (Curtis, Donlonand Wagner, eds.). New York: American Foundation for the Blind, 1970.

:innie, Nancie. Handling the young cerebral palsied child at home. Nes/

York: E. P. Dutton and Company, Inc., 1970.

3arton, M. D. Teaching the educable mentally retarded. Springfield,Illinois: Charles C. Thomas, 1964.

Gray, S. W., Klaus, R. A., Miller, J. O., & Forrester, B. J. Before firstgrade. New York: Teachers College Press, 1966.

Guldager, Virginia. Body imege and the severely handtcapped rubellachild. Watertown, Massachusetts. Perkins School for the lind,

Kephart, N. C. The slow loarncr tha classroom. Columbus, Ohio:Charles E. MarrlaI5545iiii7; 1960.

_

Long, N. J., Mbrse, W. C., & Newman, R. G. Conflict in the classroom.Belmont, California: Wadsworth Publishing company, 1966.

Lowenfeld, B. Our blind children. Springfield, Illinois: Charles C.Thomas, 1964.

BIBLIOGRAPHY

Multiple Handicaps (continued)

McCarthy, James and K:Carthy, Joan. Learning disabilities. Boston:

Allyn and Bacon, 1969.

Robbins, N. Educational beginnings with deaf-blind children. Watertown,

Massachusetts: Perkins School for the Blind, 1960.

Robbins, N. Speech beginnings for the deaf-blind child. Watertown,

Massachusetts: Perkins School for the Blind, 1963.

Robbins, N. Auditory training in Perkins deaf-blind department. Watertown,

Massachusetts: Perkins School for the Blind, 1967.

Robbins, N. and Stenquist, G. The deaf-blind rubella child. Watertown,

Massachusetts: Perkins School for the Blind, 1967.

Rosenweig, L. E. and Long, J. Understanding and teaching the dependent

retarded child. Darien, Connecticut: Teachers Publishing dWirci-TIon,

Schattner, Regina. An early childhood curriculum for multiply handi-capped children :

Siegel, E. Helpinglhe brain-Injured child. New York: New York Associa-tion for Brain-Injured Children, 1961.

White, Lilly, Herold, S., Young, N. B., & Olmsted, R. W. Pediatrician's

handbook of communication disorders. Philadelphia: 6157-FgETW7-1970.

Methodolon

Mager, R. F. Preparing instructional objectives.Fsaron Publishers, 1962.

Mager, R. F. Developing attitude toward learning:Fearon PubiTifiiii, 1%8.

Patterson, G. R., & Gullion, E. M. Living with children. Champaign,Illinois: Research Press, 1968.

Palo Alto, Cal ifornia:

Palo Alto, California:

Stephens, T. M. Directive teaching. Columbus, Ohio: Charles E. Merrill,

1970.