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Spring 2007 Table of Contents
Versión Español de este artículo (Spanish Version)

By Roger Toy, OTR, and Lisa Ricketts, OTR Texas School for the Blind and Visually Impaired, Austin, TX

Abstract: This article describes strategies and equipment that allow students with physical limitations become more independent with daily living skills.

Key Words: Programming, blind, visually impaired, deafblind, adaptive equipment, daily living skills, occupational therapy (OT), physical therapy (PT)

All students have different abilities and unique needs. Students who have physical disabilities in addition to sensory impairments often benefit from a variety of adaptations to routines, materials, and the environment. The following are examples of adaptive equipment and strategies that can be considered in order to help students with physical limitations be more independent with their daily living skills.

Eating Skills

Before considering the use of adaptive equipment to promote a student's ability to eat independently, take a look at basic positioning. The student needs to be as close to the table as possible. This will minimize the amount of food that falls into the lap and can discourage slouching, which can interfere with swallowing.

Therapists commonly recommend that positioning follow the rule of 90 degrees. This incorporates a 90-degree bend at the hip, a 90-degree bend at the knees, and 90 degrees of flexion at the ankle. This means that smaller students may need footstools when they eat in a school cafeteria so their feet don't dangle. This kind of accommodation might not be possible in all places, such as restaurants and outdoor settings, but it is important in school cafeterias, classrooms, and at home in order to develop independent eating skills.

Adaptive Equipment

Consider using some of the following materials and equipment to help promote greater independence when eating:

  • Adapted plates or dishes: HiLo dish, plate (food) guard (clear or metal), a high-sided plate (regular or partitioned), or a scoop plate. Overall, these dishes are good for the visually disabled population because they give them a physical barrier to push their food up against. They are all available commercially at medical supply stores and online.
  • Dycem (a brand name) can help stabilize the plate or bowl on the bottom to prevent it from sliding. It can also be used to stabilize other things, such as books, tabletop projects, etc. We have even used it to keep a child from sliding out of his chair.
  • For students who have physical difficulty holding things in their hands, utensils with built-up handles (foam or manufactured supergrip) and hollow-handled or cuffed utensils may help. Hollow-handled utensils allow a helper to insert a finger into the handle to teach the correct motion of scooping.
  • Adapted utensils might also work with students who have tactile or sensory deficits, coordination problems, or reduced strength. Angled spoons may help students get the food to their mouth more successfully because they require less wrist movement. Weighted utensils are good for students who need more feedback to help them grade their force when scooping food onto the utensil or if they have tremors/unsteadiness in their hands. A rocker knife or T-shaped rocker knife can be helpful for people who have the use of only one hand.

Cooking Skills and Food Preparation

Adaptive equipment can also help students develop more independence with cooking skills and food preparation, especially those who have the use of only one hand.

  • Spread boards can be used to stabilize a slice of bread, so that it does not move when spreading food over it.
  • Two pins on an adapted cutting board will hold food in place during cutting tasks.
  • A one-handed dish scrubber can be suctioned to the bottom or side of the sink to let you wash dishes, bowls, cups, and utensils with one hand.
  • The Pan Holder (suction cups) keeps the pan from turning when cooking on the stove. The suction cups don't work as well, however, when the stove top gets hot.

Dressing Skills

Students with physical or visual impairments can use adaptive equipment to dress themselves more independently.

  • Individuals with limited functional reach to their lower extremities can use a long-handled shoehorn to independently put on and take off their shoes.
  • For students who cannot tie their shoelaces because of physical or cognitive limitations, elastic shoelaces are an option, as are shoes with Velcro closures. Elastic laces turn regular laced shoes into slip-on shoes by letting the tongue of the shoe stretch to accommodate the foot. They come in two different types, Spyrolaces for younger children, and Tylastic (which look like regular shoelaces) for older students who want to look more age appropriate.
  • Reachers work well for an individual in a wheelchair who has some vision. The reacher lets the person pick up items that have dropped on the floor.
  • For some individuals with limited functional reach to their lower extremities, a dressing stick makes putting on and removing socks or pants simpler. Most of the dressing sticks can also be used as a shoehorn, but they may not be as comfortable for this use as the metal shoehorns.
  • For individuals who cannot bend down to touch their toes, the sock aid can help them get the sock over their foot (some coordination is necessary and some vision helps).
  • For the students who lack fine motor coordination or who have the use of only one hand, a button hook or a zipper pull might be useful.
  • Velcro adaptations can be made on clothing for individuals that have difficulty with fasteners, such as those often found on pants.
  • Some students at TSBVI use a device known as a Dressing Bar. A student in a wheelchair that has upper body strength and some coordination in his hands can use the dressing bar to pull to standing and then pull his pants/underwear up or down by himself. Students who have less upper body strength or coordination skills can hold onto the dressing bar while being assisted with their pants/underwear.
  • The Flipfold is a 4-panel device that can assist students with folding shirts, pants, and towels.

Hygiene/Bathing Skills

  • The foam described above for use with eating utensils can also be used on other things, such as toothbrushes, razors, hairbrushes, and pens.
  • Toothpaste dispensers can help individuals with limited finger/hand function or visual impairments put the correct amount of toothpaste on their toothbrush. The main drawbacks to these dispensers are the price (they can be rather expensive) and they only work with Aqua-Fresh 4.3- or 4.6-oz pump toothpaste.
  • Spray-can extenders can help people with decreased movement, control, or strength in their fingers.
  • There are also soap dispensers with single (like the ones you see in the public restrooms) and multiple containers that can be mounted in the shower/bathtub area for easier access for people with limited hand function or use of only one working hand. The drawbacks are that the dispensers that require drilling (for mounting on the wall) might not be possible in some bathrooms, and the dispensers held by adhesives might not hold well.
  • Long-handled sponges allow people with limited reach to wash their backs, lower legs, and feet.

These are only some of the many adaptive devices that are available. The purpose of this article is not to make you an adaptive equipment expert, but to give you a quick look at things that might help the students you work with. If you feel that a student could benefit from adaptive equipment, please contact an occupational or physical therapist in your district or contact us at TSBVI.