Dysfunction and Interventions in Eating, Toileting, and Dressing Skills

1. SpEd 417/517 Course Objective: • Demonstrate a knowledge of dysfunction and interventions in assessing and programming for the development of eating skills

2. Demonstrate a knowledge of assessing and teaching toileting and dressing skills including positioning techniques and adaptations

4. Personal Cares • Maintain health • Enhance acceptability • Reduce amount of dependency • Increase feeling of self-worth and perception of competency

5. Cause of dependency • Limited motor development • Physical or sensory disabilities • Reduced social awareness • Inadequate learning opportunities • Limited cognitive development • Combination of the above

6. Considerations • Ethical considerations • Family involvement • Timing and natural settings • Self-determination • Collaboration • Instructional strategies • Self-management

7. Eating and Feeding • Impact of eating skills on development • Nutrition • Pleasure • Social interaction • Independence

8. Eating and Feeding • Typical development • Major body systems • Skeletal system • Muscular system • Nervous system

9. Eating and Feeding • Milestones • Newborn • Sucking • Suckling • Swallowing • Six months • Semisolids introduced - suckling • Tongue pushes food to back of mouth • Lips close to take food from spoon • Munching • Chewing • Drinking from a cup

10. Mealtime skills • Finger feeding • Reaching • Grasping • Lifting food from table to mouth • Putting food into mouth • Chewing and swallowing food

11. Mealtime skills • Drinking from a cup • Place cup on lips • Tilt gradually • During swallowing, tilt cup back but maintain contact • Begin with thicker liquids

12. Mealtime skills • Using a spoon or other utensil • Picking up and holding spoon • Lowering spoon to plate or bowl • Scooping food • Lifting food from container to mouth • Inserting spoon into mouth • Removing food with lips

13. Eating and Feeding • Characteristics of multiple disabilities which cause eating difficulties • Disorders of muscle tone • Abnormal reflexes • Structural abnormalities • Learning problems • Combination

15. Eating and Feeding • Intervention techniques • Modifying positioning • Modifying foods • Modifying utensils • Modifying feeding schedules • Modifying food presentation • Modifying the mealtime environment • Providing physical assistance • Providing sensory stimulation • Providing specific training • Preventing aspiration

16. Eating and Feeding • Feeding skills • Passive feeding alternatives • Intravenous feeding • Enteral feeding • Cooperative feeding skills • Self-feeding • Finger foods • Drinking from a self-held cup • Eating with a spoon • Advances mealtime skills

17. Eating and Feeding • Nutritional concerns • Signs and symptoms • Nutritional risk factors • Diet and behavior

18. Eating and Feeding • Dental care • Dental concerns • Care and prevention

19. Eating and Feeding • Assessment and Planning • Determination of child’s abilities and limitations • Nutritional concerns • Environmental issues • Positioning • Use of utensils/equipment

21. Toileting Skills • Determining readiness • Regular pattern of elimination • Dryness for 1-2 hours • At least 2 1/2 years of age • Other characteristics • Fine motor ability • Receptive language • Visual ability

22. Teaching toilet use • Data collection • Sitting on toilet • Voiding on toilet • Attempt when student is most likely to void • Continue to check for dryness • “On/off” ratio

23. Related toileting skills • Walking to bathroom • Lifting or lowering the seat • Lowering garments and undergarments • Sitting on toilet • Wiping after voiding • Standing up • Pulling up garments • Washing/drying • Leaving bathroom

24. Dressing skills • Determining appropriate skills • Current and future needs • Normal dressing skills sequence • Physical ability • Assess ability • Use instructional strategies • Order of instruction • Prompting • Materials

25. Partial participation • Positioning • Task analysis • Modified clothing

26. Related dressing skills • Natural opportunities • Clothing selection • Purchasing • Cleaning and maintaining

27. Grooming and hygiene • Assessment of ability and needs • Task analysis • Format for data collection • Systematic instruction • Plan for generalization

28. Functional Academics • Never underestimate the learning potential of students • If one level of instruction is not successful, try another... • Traditional teaching strategies may not be successful, so implementation of modified curriculum is necessary • If students are unable to demonstrate what they know, they may still enjoy literary experiences

29. Levels of curriculum • General curriculum • Regular-adapted or streamlined curriculum • Functional or limited academic curriculum • Embedded functional instruction

30. Teaching Literacy Skills • Natural environments • Sight words • Phonics • Oral reading • Commercial materials • Comprehension & reading in real life • Writing skills • Spelling

31. Teaching Arithmetic • Basic concepts and skills • Counting • One-to-one correspondence • Addition & subtraction • Manipulatives • Handling money • Calculator • Time management • tell time • manage time

32. Instruction in the regular classroom • Cooperative learning • Incidental learning • Parallel activities • Multilevel curriculum • Curriculum overlapping • Individual instruction

33. Community Skills • Determine appropriate age to begin community instruction • Partial participation • Determine appropriate location • Determine target sites and skills • Determine operational skills

34. Community Skills • Determine associated skills • Develop instructional plans • Plan for generalization • Implement instruction • Evaluating community skills • Securing funding for community instruction

35. Community settings • Grocery stores • Restaurants • Vending machines • Pedestrian skills • Public transportation • Safety issues

36. Domestic skills • Preparing meals and snacks • Household chores • Using a telephone