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Importance of Survival Skills

Mealtime Skills

Mealtime Skills

Hi, I’m Sue Shannon, and I’m an occupational
therapist at Perkins School for the Blind. And our webcast today
is focusing on mealtime skills. We chose to do a webcast
including mealtime skills because it’s… they’re skills that we use
so frequently. Everybody eats… many people eat
three times a day, and there’s many opportunities at home, at school,
in the community, for mealtimes to take place
and for students to be learning. Mealtime skills
are also an important part of the expanded core curriculum. The expanded core curriculum is the information or skills
that are required for students who are blind
or visually impaired so that they can be successful in addition to the typical
education curriculum. These skills can be things like
daily living skills, taking care of themselves,
taking care of their homes, learning to get out and about
in the community, in addition to things like just the basics
of taking care of yourself, washing your hands
and eating meals. Blind children
don’t have the benefit of the incidental learning
that sighted children have. When they’re sitting around
at the dinner table, sighted kids can watch
their parents or their friends and see what…
how they’re eating and how they’re using
utensils. And we see little kids
imitate their parents by trying to pick up
and use utensils in a skilled way. And this is very important
for their learning. Children who are blind
don’t have this opportunity to just casually observe
and learn, so these opportunities
need to be presented to them in a very systematic
and structured way so that the students
have the opportunity to practice these
special techniques so that they can be
as successful as their sighted peers. This webcast also offers
a great opportunity for us to use visual demonstration
for these skills. Sometimes it’s hard for us
to convey this information written in book form
or in emails or phone calls to other schools or families, and we have
this great opportunity to show a video demonstration
of the skills so that they can hopefully make
more sense. We are going to demonstrate
a few different skill areas: pouring, serving,
using utensils, and cutting. And we’re going to show
a few different techniques for each of those skills,
and then a few adaptations for students who are on
different levels of learning. I just want to emphasize that there is no one right way
to cut foods or to pour a drink for someone who is blind
or visually impaired. It’s just really whatever works
for the student. I think that the students
often come to us with their own little techniques
that they’ve made up that’s worked for them, and we like to go with that
and we can learn from them. This webcast is part of a series on daily and independent
living skills, and also is paired with a
publication on the same topic. Mealtimes are a very important
time for all of us. We eat so many times a day, and mealtimes are often paired
with social experiences. We have meals with our friends
in school or go out to restaurants,
out for dinner. There’s a lot of family holidays
that are focused around food. Things like even weddings
and other parties a lot of times are focused
around mealtimes. And so having good social
skills, good mealtime skills, are important for that
social experience. Also when kids are in school, lunchtime is a very,
very important time for that social interaction, and it’s really easy
to be isolated if you’re perceived as a person that doesn’t have
good mealtime skills. So really, it’s really doing
a favor to the students to help them work
on those skills. There are many, many skill areas
involved at mealtimes, and today we’re
just going to focus on pouring, serving,
utensil use, and cutting. But there’s also other skills. As I mentioned, social skills– having conversations,
good manners at meals– and even spatial skills,
or math. There’s just lots and lots
of opportunities for learning. I think it’s important
when you’re teaching… or even when you’re
not teaching children, when you’re at a meal
with a child with a visual impairment, it’s
important that they’re involved and have some opportunity
for the observation, the exposure to these skills. And having the chance to observe
these adapted techniques, even if you’re not actively
teaching at the time, is important for the students
to gain some exposure. So if, for example,
you’re pouring a drink, the way a sighted person
would pour a drink is very different than the way
a visually impaired person would pour a drink. So demonstrating
the adapted technique that the child may use
later in life, it would be beneficial for them. It’s important, too,
to set up the environment so it’s helpful for learning. For learning, organization
is very important, especially for children
who are totally blind, to be able to predict… to have a predictable
environment, one that they can know
what to expect and know where to find things, can make mealtimes
go much smoother. So if you always have
the fork on the left and your spoon and knife
on the right to try to keep the setup
that way so that the students know
where to find the utensils when they’re struggling
to learn. Also, just having
a clear pathway, maybe, from the table to the kitchen
will be… sort of invite the student to go back and forth
from the kitchen and maybe be more involved
in the mealtimes, or help to clear the table
after dinner. Even simple things like pushing in the chairs
after the meal too can help with the safety
around mealtimes. If you’re walking, taking your dirty plate
and knife to the kitchen, it would be good not to have
chairs around to trip over. And just lastly, the involvement again
is very important, I think, for the children who are blind so that they don’t just develop
the sense that when they get placed
at a table at a meal, that food doesn’t just arrive
in front of them and for their benefit
just to eat, and then the dirty things
disappear and they have no idea
of where it goes. So it’s important that even if you’re just explaining
to your child as you go along from making
dinner or making lunch in a group at school, to be able to explain
to the student what’s going on, and to have them
just be participating even at the littlest level,
to keep them involved. And now we’re going to talk
about pouring. Pouring is a little bit
challenging of a skill, because there are
so many different containers to pour from. There’s milk bottles,
milk cartons, milk jugs, all kinds of variety
of juice bottles, soda, and it’s hard to sort of
generalize this skill because there’s
so many differences in the bottles
that liquids come from. So one thing that’s
kind of helpful to try is to see if you can pick up
a small pitcher that has a pronounced lip
or spout, and that’s a great way
for students to learn to be really successful, to use something that has
a very clear and simple method for pouring from. And again, I mentioned before, but I think it’s important again
to say when you’re teaching
these skills, it’s very important to provide
hand under hand demonstration. When you’re providing a student’s opportunity
for observation, to make sure that they’re aware
that there are these techniques to make it more successful. The first technique
we’ll demonstrate is using your index finger to monitor the amount of liquid
in the glass. What we’re going to do is
bring the cup up to the spout and find the spout
with your index finger. Try to keep your finger
on the outside of the spout so that you don’t
get your fingers inside where the drink
is coming out, especially if your fingers
aren’t clean. So once you feel that the spout
is over the cup, begin to move the cup and
the pitcher at the same time, until the cup is flat
on the table. Make sure to keep your finger
inside the cup to monitor… to see if the fluid’s
going inside. And then you know to stop when
the liquid hits your finger. Okay, another method
that could be used, which is particularly helpful
if the container’s very heavy, is to allow the pitcher
to slide down below the level
of the tabletop and start lining up the cup
with the spout from there, again, using your finger
to align the cup… edge of the cup with the spout,
and then this way, you don’t have to move the cup
and the pitcher at the same time. You can just stabilize the cup
on the tabletop. Another method for students
that maybe don’t like to get their fingers wet
inside of the cup, can’t tolerate the feeling
of the liquid on their fingers, of if you’re pouring a drink
that’s too hot that you couldn’t put your
finger inside the cup or you would burn yourself, you could use what’s called
a liquid level indicator. And these are available
from Independent Living Aids, among some other suppliers
of specialized equipment for people with visual
impairments. What you do is you take
the liquid level indicator and place the two prongs
inside the cup and the battery part hanging
on the outside of the cup. Then you can pour the drink without having to put
your fingers inside. When the drink gets to the level
of the cup where the prongs are, it makes a noise… (device beeps) …indicating when to stop. And now we’ll talk a little bit
about serving. Just as in pouring, there’s a variety
of containers, utensils, and different types of foods
that are presented to a child. And this poses some challenges when learning to serve
themselves from a platter, a bowl,
or a dish, because there is such
a great variety, and it’s difficult
to generalize this skill. It’s important when
a student’s first learning to describe what it is
that they’re having in detail. Maybe not just to say, “We’re
having chicken and potatoes,” because that can sort of evoke a whole variety
of different ideas of how… what you’re going to be eating
and how it’ll be presented, but to maybe say, “We’re having chicken cutlets
with mashed potatoes, and we’ll be using a spoon
with the mashed potatoes, “and the chicken cutlets
will be on a platter with the serving fork.” And that way the student
can begin to anticipate what it is that they’re
going to be expected to do and can kind of go into it with an image of themselves
performing the skill. The easiest skill, I think, is to serve from a bowl
with a spoon. And sometimes it’s easier if you’re just going to have
a student learn one thing or serve themselves one item to do something that
will be successful for them, to use the spoon and a bowl to serve themselves, say,
peas or corn niblets, which is something
that’s fairly easy and successful for them to do. So now we’re going
to serve some peas from a bowl with a spoon. And if you’ll reach out
for the platter to the left, using both hands, bring the bowl
to touch your plate. Trace around the bowl
with your finger to find the utensil. And stabilizing the bowl
with your left hand, scoop toward your left hand. And then stop and wait until you locate your plate
with your opposite hand. Make sure you have a place
for the peas, and then turn
the spoon over gently. Now you can use your left hand
to find the plate… the bowl, rather,
and return the spoon. Now you could pass that bowl
to the right, to the next person at the table, and reach out now
for the platter that has chicken cutlet,
baked chicken cutlet, with a serving fork. Again, you’re going
to trace around to find the fork. Then, using the fork,
sort of check around the platter to see if you can locate
the piece of chicken and guess where the middle
might be. Pierce it, and again,
pause to locate your plate, remembering to find a place
that’s not on top of the peas, maybe on the other side
of the plate from where you put the peas. And bring the chicken
to your plate. And if it doesn’t come off
of the fork easily, you could use your own
clean utensil that hasn’t been used yet
to encourage it off. The next demonstration we have
is using utensils. Utensil use
could really pose a challenge for someone who’s blind,
because it’s like using tools. Their fingers aren’t the things
that are getting the feedback immediately from the food. The tools are in their hand, they’re an extension
of their fingers, and all the action is taking
place away from their hands. So it makes it sort of difficult
for a student, especially that has difficulty conceptualizing space
outside of their own body, to be able to develop skills
with utensils. We’ll demonstrate the transition
that a student… a child might go
from holding a spoon to changing into a grasp
for a fork, and then using their utensils
maturely, as adults. Typically young children
hold a spoon when they’re first learning
to feed themselves with a fist, like this. And that doesn’t offer them
a lot of control over the utensil– just enough to get
whatever’s in their bowl, usually a sticky sort of food, onto the spoon
and into their mouth. As their hands begin to develop
more fine motor control, the control in their fingers,
you’ll see that they tend to hold the spoon more
with their fingers than with their fist. And this is a…
with the grasp in this way, they can sort of manipulate
the spoon a little bit more in a more controlled way
so that they can get different types of food
off of their plate. Now, this might be a good time
to introduce a fork, because a fork requires
a more distal grip, but with the palm turned up, to be able to pierce foods
effectively and to be able to locate things
on their plate. There are several different
adaptations to utensils that can help encourage
this development if it’s a student
that’s having some delays in their development. When a student
is first using a spoon, they could use
a wider grip spoon and maybe a spoon that has
a bit of an angle to it to help them keep the spoon
going in the right direction. Maybe with a fork,
as they’re learning the fork, something with a larger grip to help them balance the fork
in their hand more easily so that they can manipulate it
with their fingers. You could also make
customized forks, customized grips on your fork, so that a student
has kind of a map for where to put their fingers. And then for students when they’re first starting
to use a fork, to be more successful
in piercing, they can use something
like a spork so that they can
locate the foods, pierce it, and then also scoop to make sure they get something
on their plate so it doesn’t get frustrating. All of these utensils
can be found at any rehabilitation
equipment company or medical supply company. Many times, one that we like
to use is Sammond Preston. This customized grip can be
created with a polymer clay, and there’ll be a link
to that information below. Another important skill
for neat eating is to be able to use your knife
as some sort of an assist to get the food onto the fork
so that you don’t end up chasing the food
around the plate or knocking the food
off the plate or using your fingers. So to demonstrate this, we’ll hold the knife
against the edge of the plate, the side of the plate opposite
to where you’re scooping, and scoop into the knife to help keep the food
onto the utensil. Now, you could also put
the knife closer to your body… …and scoop into it
in that direction. It’s really sort of
more the preference of how the student
tends to scoop with their utensil. Now, another skill
which is more complex is to use a knife as a pusher, where the knife is pushing
the food onto the fork, and so both utensils are moving
at the same time. And this is
a little bit more advanced because you’re using
two hands at once rather than just kind of parking
one hand with the knife. When you’re using it as a border
or using it as a pusher, both utensils are acting
at the same time. Now, to encourage more success
in the beginning when a student’s first learning
to use this skill, a wider blade knife
can be helpful. It sort of gives you
more surface area, and that way, the fork
maybe won’t get caught underneath the knife, or the knife won’t end up
wandering up off of the plate. And so just as
with the other knife, you could use it
in any position on the plate where the student would find it
more successful. One adaptation to being able
to use a knife as a border, if a student isn’t quite ready
for that skill yet because they don’t have
very good use of skills for holding utensils yet
or tools, using tools, understanding the concepts
of how the knife works away from the fingers, you might be able to use
a piece of roll or a piece of bread
as a pusher. And that way, the student’s
hands are still close and can still kind of monitor
what’s happening with the food and going onto the fork, but don’t quite have their hands
in their food. Another idea would be
to try a tip of a spatula, which is sort of similar. The tip of the spatula
may not be as temping to take a bite out of
as the roll might be. For students who really aren’t
able to use two hands, because they have
some sort of inability to use one hand
for a motor issue, they could use a plate guard, which is a plastic rim
around the plate. This is another device that
can be found at Sammons Preston or another rehabilitation
equipment company. The plate guard then acts
as a border, so when you scoop
across the plate, you can use the plate guard
to hold the… keep the food onto the fork. Now, sometimes you might
want to try to do this… use a plate guard
when we’re first introducing the idea of using a knife
as a border, because some students
can’t tolerate holding the knife
throughout the entire meal or aren’t very successful
with it right in the beginning, so we want to make sure that they do actually get something
onto their fork, even if the knife
isn’t working for them. Next, we’ll look
at cutting foods. Now, this is another somewhat
difficult skill to learn, because again, there are so many
different things to cut, and there’s different
resistances of the foods, the foods come in different
shapes, or even just… it’s hard to expect… to imagine what the food’s
going to be like when it comes to you, even if
you know it’s broccoli spears. You know, some people
cook broccoli spears so they’re very squishy,
and some are very firm, so it’s difficult
to anticipate again. So learning to cut
a whole variety of foods is really important for kids. I think it’s important that if you’re teaching a student
to cut, again, using a very systematic
approach is very helpful to help develop a way
to generalize the skills. And we’ll demonstrate a few
of those techniques. I think it’s important that once you find a technique
that works and is successful with your child or your student, to make sure that all the people
that are teaching them or demonstrating for them
are using the same technique, paying particular attention to whether the student
is left or right handed. Particularly in cutting,
because we switch utensils, so it’s important that the student learns the same way
all the time. Next, I want to demonstrate
using a knife and fork to cut. We’re going to take the fork
and locate the piece of meat. Now, they’re holding the fork
in the non-dominant hand. If the person’s right-handed, they’d be holding the fork
in their left hand to locate the piece of meat. Find the edge of it and slide over a bite-size
amount and pierce it. Then taking your knife
in your dominant hand, the hand that requires
more skill… that has more skill and requires more skill
to use the knife than it does just to stabilize
with the fork. That’s why we teach it
that way. You take the knife, find
the cutting edge of the knife, either on the side of the plate
or the fork, and slide down the back
of the fork and saw back and forth
until you get to the plate. And then once you’ve gotten
that piece cut, you’re going to reach the knife
under the fork to hold the meat stable, while the fork then jumps
over the knife. Roughly a bite-size amount. And then you can repeat it, sliding down
the back of the fork and sawing back and forth. So if you notice
while you’re eating that one piece is maybe
a little bit too big, you can put the piece of meat
back down, switch hands
so you’re holding the fork with your left hand again,
pick up your knife, slide down the back of the fork, and that should be enough
to cut the piece into a smaller bite-size piece. Using Dycem underneath the plate
can help. This blue mat
underneath the plate can help to keep the plate
from sliding around when a student’s
first learning to learn how to modulate
the force when sawing back and forth without sliding the plate
all over the table. Okay, so now we’re going
to demonstrate a method for cutting spaghetti. Spaghetti is generally
very, very messy and very difficult to eat, but kids love it,
so this is a way that kids can be a little bit more
successful with spaghetti. If you take your fork and knife
in each hand… and you’re going to begin
in the far part of your plate. I would say the front
or the back, but that’s sometimes confusing. So the part of the plate
that’s farthest away from you. You’re going to cross
your knife and fork together and pinch the ends as you
squeeze and pull them apart. You’re going to repeat that all the way across the plate
towards you. And when you get to the part
that’s closest to you, you’re going to place your left
hand and your right hand on the sides of the plate,
and turn the plate so that your right hand’s
at the top and your left hand’s
at the bottom of the plate. That’s a quarter turn. And then you’re going
to repeat that again, so starting at the far end
of the plate, pinch your utensils together as you drag them
across the plate. Now you should have
a roughly bite-size amount that will stay on the fork. As I mentioned before,
I think it’s really important that students feel that
they’re involved, you know, they’re involved
in a way that they’re learning, that they are participating, and that they feel
a part of things rather than just having things presented to them
and taken away. They develop a sense
of responsibility in that way for knowing
where the food comes from, that somebody is responsible
for bringing the food, cooking the food,
preparing the food, and cleaning up,
and that they can take a part in those responsibilities
eventually as they get older. A lot of times for students, it’s important
to have a role at meals, to be the one that maybe
brings the napkins to the table or brings out the drinks. To have a job helps to develop
that sense of responsibility and contributing to the family
or to the classroom. A couple other ideas maybe are to help with part
of the meal preparation, even if it’s just, you know,
stirring something, or maybe setting the timer to know when the dinner’s
going to be done. Maybe a student can…
or your child can offer to carry one of the serving
dishes to the table if you eat family style, or also to clear the table
at the end of the meal. Also it may be nice
for a student to learn to clear a guest plate
who might come for dinner and maybe even learn
to rinse the dishes and put them in the dishwasher
eventually. This webcast is one
in part of a series on daily and independent living
skills presented by Perkins. If you’d like more information
on this topic, you can follow the links below, or contact us by email
if you have any questions or comments
about this presentation.

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