5.1 Occupational Therapy – Definition, Objective, Scope, Modalities and Intervention

Occupational therapy (OT) treatment focuses on helping people with a physical, sensory, or cognitive disability be as independent as possible in all areas of their lives.

In OT, occupations refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life.

The primary goal of OT is to enable people to participate in the activities of everyday life.

Occupational therapy interventions focus on adapting the environment, modifying the task, teaching the skill, and educating the person in order to increase participation in and performance of daily activities, particularly those that are meaningful to the person.

Occupational therapists often work closely with professionals in physical therapy, speech therapy, nursing, social work, and the community.

Children who need OT

According to the AOTA, children with the following medical problems benefit from OT:

-         birth injuries or birth defects                               

-         sensory processing disorders

-         traumatic injuries (brain or spinal cord)              

-         learning problems

-         autism/pervasive developmental disorders       

-         juvenile rheumatoid arthritis

-         mental health or behavioral problems                

-         broken bones or other orthopedic injuries

-         developmental delays                                        

-         post-surgical conditions

-         burns                                                                  

-         spina bifida

-         traumatic amputations                                         

-         cancer

-         severe hand injuries

-         multiple sclerosis, cerebral palsy, and other chronic illnesses

Objectives of Occupational Therapy

Through the years, three general objectives of occupational therapy have evolved:

§  Diversion: The primary objective is to divert or distract attention away from the disease or disorder toward more healthful ideas and positive thinking i.e. toward useful tasks or occupations such as painting, weaving, pottery, sewing, or woodworking and amusements which included playing games, listening to music, playing music, watching or performing plays, participating in playful exercises and sports, as well as doing a variety of arts and crafts.

§  Emotional Expression: Emotional expression, also called creative expression, became important to occupational therapy as through the use of the creative arts and crafts patients can express attitudes, feelings, and ideation, express hostility, dependency, and infantile oral and anal needs.Develop better self-concepts, improve personal identities, and build more healthy egos.

Creative arts and crafts provide opportunities of reality testing as well. The objects and processes offer sensory contact, shared values, and consensual validation.

The use of expression dominated occupational therapy in psychiatry in the 1960s and 1970s.

§  Skill building: Skill building has been a part of occupational therapy from the beginning, but its purpose has expanded in recent years. Initially, skills were primarily honed in relation to work situations.

During the 1950s, the concept of activities of daily living (ADLs) was added to the objective of skill building. Activities of daily living, also called self-care, included such tasks as dressing, grooming, walking, and eating.

In the 1970s, skill building began to be described in three or four areas called self-care or daily living skills, work or productivity, and play-leisure or recreation and three to five components called physical, motor, sensory, sensorimotor, cognitive, intrapersonal, psychological, interpersonal, social, psychosocial, or cultural. Gradually, the term ‘performance’ became a key concept.

These objectives provide the framework for more specific and more individualized goals and objectives.

Objectives of OT for Children/ Persons with Special Needs

The objectives of occupational therapy for children/persons with special needs are to:

§  help children work on fine motor skills so they can grasp and release toys and develop good handwriting skills

§  address hand-eye coordination to improve child's play and school skills (hitting a target, batting a ball, copying from a blackboard, etc.)

§  help children with severe developmental delays learn basic tasks (such as bathing, getting dressed, brushing their teeth, and feeding themselves)

§  help children and adults with behavioral disorders maintain positive behaviors in all environments (e.g., instead of hitting others or acting out, using positive ways to deal with anger, such as writing about feelings or participating in a physical activity)

§  teach children and adults with physical disabilities the coordination skills needed to feed themselves, use a computer, or increase the speed and legibility of their handwriting

§  evaluate a child's need for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids

§  work with children and adults who have sensory and attentional issues to improve focus and social skills.

5.2 Physiotherapy – Definition, Objective, Scope, Modalities and Intervention

According to the definition adopted by WHO, physiotherapy is "the art and science of treatment using therapeutic exercise and physical agents such as heat, cold, light, water, massage, electricity, etc. In addition, physiotherapy includes the execution of manual and electrical tests to determine the level of intervention required to recover muscle strength, joint movement and the range of vital capacity, as well as diagnostic aids for monitoring recovery. Physiotherapy aims to develop, maintain and restore the maximum degree of functional capacity in people with somatic, psychosomatic and organic disorders, or in those whose health or quality of life has been negatively affected.

Objectives  of Physiotherapy

Physical therapy (PT) is care that aims to ease pain and help you function, move, and live better. Specifically, physical therapy looks to achieve these objectives for their patients:

Physical Therapy: Methods And Treatments

At the first physical therapy session, the physical therapist assesses your needs. A history of your pain, symptoms, ability to move and your medical history will be taken.

Tests will measure:

Treatments can include the following:

Physical Therapy: BenefitsPhysical therapy is the conservative approach to managing health problems, and in many cases the first resort advocated by doctors and health professionals.  Indeed, it may help people of all ages who have medical conditions, illnesses, or injuries that limit their regular ability to move and function.

Physical therapy can be a benefit for the following conditions:

Common Physiotherapy Treatment Techniques

Hands-on Physiotherapy Techniques

Your physiotherapist may be trained in hands-on physiotherapy techniques such as:

§  Joint mobilisation (gentle gliding) techniques, 

§  Joint manipulation, 

§  Physiotherapy Instrument Mobilisation (PIM).

§  Minimal Energy Techniques (METs), 

§  Muscle stretching, 

§  Neurodynamics, 

§  Massage and soft tissue techniques

In fact, your physiotherapist has training that includes techniques used by most hands-on professions such as chiropractors, osteopaths, massage therapists, and kinesiologists.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent injuries. 

Some physiotherapists are also skilled in the use of kinesiology taping.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises have been scientifically proven to be one of the most effective ways that you can solve or prevent pain and injury. 

Your physiotherapist is an expert in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result.

They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. 

Your physiotherapist is a highly skilled health professional with superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of repeat injury. 

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Workplace Physiotherapy

Not only can your physiotherapist assist you at sport, they can also assist you at work. Ergonomics looks at the best postures and workstation set up for your body at work. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

 

5.3 Speech Therapy – Definition, Objective, Scope and Types of Speech, Language and Hearing Disorders and Intervention

Communication is unique to human being which has a major role in all walks of life, and gives human beings a distinct identity. Communication is achieved verbally or nonverbally with the use of language. Communication refers to the sending and receiving of messages, information, ideas or feelings (Hulit and Howard 2002). Speech and language are the components of communication. Bloom (1988) describes language as a code whereby ideas about the world are represented through a conventional system of arbitrary signals for communication. Speech is the oral expression of language (Hulit and Howard 2002).

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

What is Speech Therapy? “Speech Therapy is a rehabilitative procedure undertaken in order to help the people having any kind of Communication Disorders or Problems and some swallowing problems”

 

Or, it is the treatment of speech and communication disorders. The approach used varies depending on the disorder. It may include physical exercises to strengthen the muscles used in speech (oral-motor work), speech drills to improve clarity, or sound production practice to

improve articulation.

 

Who is a ‘Speech Therapist’? A person who specializes in the diagnostic procedures, evaluation techniques, assessment tools and various therapeutic techniques related to different communicative disorders.

 

 

Speech and language therapists assess and treat speech, language and communication problems in people of all ages. They help people to become independent communicators using speech, gesture and/or communication aids as needed. They also work with people who have eating, drinking, chewing and swallowing difficulties. They work as part of a multidisciplinary team and have close links with teachers, doctors, nurses, psychologists, occupational therapists and other health professionals. 

A speech pathologist's narrow, well-defined objectives work toward achieving broad therapeutic goals. This professional develops an individualized treatment plan for each patient, which often includes time-based objectives. For example, his objectives may include helping a patient correctly say several new sounds by the end of a quarter, marking period or year. Other objectives can include helping a patient to understand and to explain a speaker's gestures, demonstrate newly learned conversation strategies, explain the perception of body language, speak for a period of time without stuttering and improve reading comprehension to a specific level.

The main objectives of speech therapy is to improve communication. Some of the goals of speech therapy might include:

·         Improving coordination of speech muscles through strengthening and coordination exercises, sound repetition and imitation.

·         Improving communication between the brain and the body through visual and auditory aids such as mirrors and tape recorders.

·         Improving fluency through breathing exercises.

·         Enhancing the learning of language through language stimulation and the use of language through positive reinforcement.

·         Improving communication by helping a child learn alternative way to communicate. This might include gestures, signing or augmentative communication devices.

Each child will have a different outcome depending on his or her particular challenges and abilities. The length of time in speech-language therapy depends on many factors such as severity of the problem, the frequency and consistency of therapy and the consistency of help at home.

WHAT ARE SOME TYPES OF SPEECH AND LANGUAGE DISORDERS

Delayed language 

Children with delayed language learn words and grammar much more slowly than other children. There are many reasons for delays in speech and language. Hearing loss is a common reason. A child who cannot hear well or at all will have trouble learning, copying, and understanding language. Speech delays may also be caused by what is called “oral-motor” problems. Oral-motor problems are difficulties with using the lips, tongue, and jaw to make speech sounds. Sometimes these problems start in the areas of the brain that are responsible for speech and language development.

Children are different from each other in the way they develop. Some are faster, and some are slower, but they might all be developing normally. It is hard to tell if there is a real language delay. There are some guidelines about children’s speech and language skills that will help you decide if the child is delayed. These are known as “developmental milestones.” 
Articulation disorders

Articulation means making sounds and words. To do this, the lips, teeth, tongue, jaw, and palate (roof of the mouth) need to move together to make shapes. They change the movement of the air that comes from the vocal chords. That is how people make sounds, syllables, and words. A child has an articulation disorder when he makes sounds, syllables, and words incorrectly. The listeners do not understand what he is saying.

There are three types of articulation disorders. They are called omissions, substitutions, or distortions. Omission means leaving something out. An example of a speech omission is saying “at” for “hat” or “oo” for “shoe.” Substitution means putting something where something else belongs. An example of a speech substitution is the use of “w” for “r” and saying “wabbit” for “rabbit.” Another example is using “th” for “s” and saying “thun” for “sun.” Distortion means that the parts are mostly there, but they are a little wrong. The child says a word that sounds something like what it should, but it is not quite right. An example is “shlip” for “ship.”

Articulation disorders are not the same as “baby talk.” It is important to know the difference. Baby talk happens in young children who mispronounce words. That is normal and not a disorder. In older children it is no longer cute. Articulation problems then get in the way of good communication. Sometimes a different accent may be confused with articulation problems. An accent is a problem for a child only if it gets in the way of the child’s communication. As a general rule, a child should be able to make all the sounds of English by the age of 8.

Articulation problems may come from: 
   • Physical handicaps such as cerebral palsy, cleft palate, or dental problems
   • Hearing loss
   • Incorrect speech and language models for a child

Stuttering

Stuttering is when speech does not flow smoothly. It is interrupted by: 
   • Stopping in the middle (no sound comes out at all)
   • Repeating sounds (for example, st-st-strong)
   • Holding a sound or syllable for a long time (for example, sssssssstrong)

When children stutter, they often blink their eyes quickly. Their lips might shake, or they might move in another way that shows they are struggling to get the word out. “Stuttering” is the same as “stammering;” the words mean the same thing.

Most children stutter a little when they learn to talk. It is most common in children between the ages of 2 and 6. They are just starting to develop their language and speech skills. Boys are three times more likely to stutter than girls. Stuttering when learning language is natural and common. Most children outgrow it.

Some children may stutter more in certain situations. They may stutter when they have to speak in front of many people or speak on the telephone. Some children who stutter may not do so when they talk to themselves or when they sing.

Stuttering may be caused by:
   • Developmental causes – Developmental stuttering happens when a child is learning to talk. He cannot find the words that
     he wants to say as fast as he thinks. This type of stuttering is normal. It goes away as the child grows. 

   • Neurogenic causes (causes that start in the nervous system) –Stuttering may be caused by problems in the brain,
     nerves, or muscles. The part of the brain that is responsible for speech and language development may be damaged by a
     stroke or by a head injury. The muscles that are responsible for forming sounds and words may be damaged. 

   • Psychogenic causes (causes that start in the way a person thinks or feels) – Stuttering may be caused by severe
     damage or stress to the mind. This type of stuttering happens in children with mental illness. Very few children stutter
     because of these causes.

   • Hereditary causes – Stuttering may run in the family and be passed to a child from her parents. Some experts disagree
     with this theory.

Voice disorders

A voice disorder happens because the vocal cords that produce sound are damaged. The vocal cords are the muscles in the throat that are responsible for making sounds and words. Children can damage their vocal cords by shouting, screaming, and talking extremely loudly and very often. Their voice may become harsh and they may find it very difficult to talk. Also, when they try to talk, their throat may hurt a lot. Voice disorders are sometimes called “voice abuse.”

Voice disorders in children can be corrected with speech therapy. In speech therapy, children are taught to speak softly. They are also taught not to scream, shout, or do anything that may hurt their vocal cords and affect their voice. Remember that children like to copy what the adults around them do. So if they see you speaking loudly or shouting, they will do the same. Practice speaking softly so that the children around you will do the same.

Voice disorders are not common in children. Also, they are usually temporary.

Aphasia

Aphasia is a language disorder. It is caused by injury to those parts of the brain that are responsible for language. This is mostly the left side of the brain. Aphasia may be caused suddenly, perhaps from a stroke or a head injury, or it may develop slowly, perhaps from a brain tumor.

Aphasia affects the way children talk and the way they understand what others are saying. It weakens a child’s ability to read and write.

Aphasia is very rare in children.

Speech and language disorder due to hearing impairment

Children learn to talk by listening to speech. The first few years of life are a critical time for speech and language development. Children must be able to hear speech clearly in order to learn language. A fluctuating hearing loss due to repeated ear infections might mean the child doesn't hear consistently and may be missing out on critical speech information. Permanent hearing loss will also affect speech and language development, especially if it is not detected early. The earlier a hearing loss is identified and treated, the more likely the child will develop speech and language skills on par with normally hearing children.

Types of Hearing Loss

There are four types of hearing loss:

·         Auditory Processing Disorders

·         Conductive

·         Sensorineural

·         Mixed.

Auditory Processing Disorders

Auditory Processing Disorders occur when the brain has problems processing the information contained in sound, such as understanding speech and working out where sounds are coming from.

Conductive Hearing Loss

Conductive Hearing Loss occurs when there is a problem with the Outer or Middle Ear which interferes with the passing sound to the Inner Ear. It can0 be caused by such things as too much earwax, Ear Infections, a punctured eardrum, a fluid build-up, or abnormal bone growth in the Middle Ear such as Otosclerosis. It is more common in children and indigenous populations.

Sensorineural Hearing Loss

Sensorineural Hearing Loss occurs when the hearing organ, the Cochlea, and/or the auditory nerve is damaged or malfunctions so it is unable to accurately send the electrical information to the brain. Sensorineural Hearing Loss is almost always permanent.

It can be genetic or caused by the natural aging process, diseases, accidents or exposure to loud noises  such as Noise-induced Hearing Loss and certain kinds of chemicals and medications. Auditory Neuropathy is another form where the nerves that carry sound information to the brain are damaged or malfunction.

Technologies such as Hearing Aids, Cochlear Implants can help reduce the effects of having Sensorineural Hearing Loss.

Mixed Hearing Loss

A Mixed Hearing Loss occurs when both Conductive Hearing Loss and Sensorineural Hearing Loss are present. The sensorineural component is permanent, while the conductive component can either be permanent or temporary. For example, a Mixed Hearing Loss can occur when a person with Presbycusis also has an Ear Infection.

INTERVENTON

Interventions for children identified as having speech and/or language disorders include a variety of practices (methods, approaches, programmes) that are specifically designed to promote speech and/or language development or to remove barriers to participation in society that arise from a child’s difficulties, or both.

Intervention may take place in many different environments, for example, the home, school or clinic and will vary in duration and intensity dependent on the resources available, perceived needs of the child and policies of individual speech and language therapy services. Intervention may also be delivered indirectly through a third person or directly through the clinician. Direct intervention focuses on the treatment of the child either individually or within a group of children depending on the age and needs of the children requiring therapy and the facilities available. Indirect intervention is often perceived to be a more naturalistic approach where adults in the child’s environment facilitate communication.

Any type of intervention designed to improve an area of speech or language functioning concerning either expressive or receptive phonology (production or understanding of speech sounds), expressive or receptive vocabulary (production or understanding of words), or expressive or receptive syntax (production or understanding of sentences and grammar).

Goals for Early Intervention

Promote pre-linguistic communication

·        Communication intention (e.g.,Request, comment, protest)

·        Communication modalities

1.     Vocalizations

2.     Gesture

3.     Sign

Early linguistic communication

·        Early vocabulary development

·        Word combinations

·        Syntax/morphology

·        Articulation

·        Pragmatics

Early Intervention, especially where language delay is involved, works best when the following techniques are learned, used, and established: 

 

·        Joint Attention Skills: When looking at pictures, reading books, or even just playing with children, especially those with, decreased vocabulary, it is important that the child engages or attends to an object, picture, or toy that the caregiver is talking about. This ensures that the child is listening and is able to receptively understand the object or picture being labeled and described. 

 

·        Turn-Taking: This is teaching children to respond to physical and verbal cues, which helps set the stage for adequate communicative exchange in which there is a speaker and a listener. For example, if the parent pushes the car to the child and says “vroom-vroom”, the parent waits for the child to respond by pushing the toy car back to them and imitating the sound. Some children need to be taught this skill explicitly to establish meaningful communicative exchange. 

 

·        Language Stimulation: The caregiver or care providers follows the child’s lead during play or in everyday activities and responds to the child’s actions by saying out loud what they are doing such as naming the item they are manipulating, talking about the action the child is performing with the object, and describing the physical characteristics of the object. All this is done while not requiring the child to respond or to say a specific word or sentence. Only stimulating their language and providing them with temptation to talk. 

 

·        Play Skills: how children discover and learn about objects, people and the world around them. Through play, children often show us what they understand about the world. Play is a good skill to teach speech and language concepts relevant to children’s everyday life, which will help them to become better communicators. 

 

In typically developing preschool children, language is developing at a rapid pace; their vocabularies are growing, and they are beginning to master basic sentence structures. For children with language difficulties, this process may be delayed. For children in this population, areas targeted for intervention typically include:

phonology

semantics

morphology and syntax

pragmatics

Treatment Modes/Modalities

The treatment modes/modalities described below may be used to implement various treatment options.

Augmentative and Alternative Communication (AAC)—supplementing or replacing natural speech and/or writing with aided (e.g., picture communication symbols (PECS), line drawings, speech generating devices, and tangible objects) and/or unaided (e.g., manual signs, gestures, and finger spelling) symbols. Whereas aided symbols require some type of transmission device, production of unaided symbols only require body movements. .

Computer Based Instruction—use of computer technology (e.g., iPads) and/or computerized programs for teaching language skills, including vocabulary, social skills, social understanding, and social problem solving.

Facilitated Communication—use of a "facilitator" who provides physical and other supports in an attempt to assist a person with a significant communication disability to point to pictures, objects, printed letters and words, or to a keyboard and thereby communicate.

Video-Based Instruction (also called Video Modeling)—use of video recordings to provide a model of the target behavior or skill. Video recordings of desired behaviors are observed and then imitated by the individual. The learner's self-modeling can be videotaped for later review.

Effective communication is fundamental to human development and plays a critical role during the formative years of a child’s life. Without the ability to communicate clearly, children lose access to many of the educational experiences that will mold them into adults. The situation is frustrating and debilitating for the children involved, and stressful and painful for their families. Speech language pathologists can step in to address those problems at the very source with life-changing therapeutic interventions that make a real difference for those children and their families.

 

5.4 Yoga and Play therapy – Definition, Objective, Scope and Intervention

YOGA

Yoga is a system of mental, spiritual and physical development which originated in our country. Yoga means to bind together. There are many branches of yoga. The popularly used one is Hatha Yoga, which involves expression and conservation of energy. This type of yoga incorporates asanas (postures) along with pranayama (breathing exercises). Yoga is being tried quite effectively to control children with hyperactivity.

The teacher must be well trained in yoga before teaching children with mental retardation.

Differences between physical exercise and yoga

2.5.1 Yogasanas and adaptations for persons with mental retardation

Practice of Yoga is being tried with children with mental retardation to

Practice of yoga involves Asana – meaning posture and Pranayama – meaning regulated breathing. An individual doing asana must experience comfort and should maintain steadiness in given posture (Desikachar, 1982).

Pranayama is usually praticed in a comfortable sitting position. It involves breathing in, holding breath, exhalation and retention after exhalation.

There are five basic positions in which asanas can be performed: 1. Standing, 2. Supine (lying), 3. Inverted, 4. Prone (lying), 5. Sitting, kneeling.

What type of Asanas can persons with mental retardation perform?
How can I teach breathing techniques?

Eg.1. Uttanasana

Here, the posture begins with standing movement. Ask the student to raise hands, then bend forward, and touch the floor. Ask him to slowly come back to standing position.

Some children may have difficulty in raising both hands. Break task into smaller steps.

i. Ask child to stand. Provide support of a bar or wall if required.
ii. Let him raise one hand first, then the other.
iii. If he has difficulty in maintaining this posture, place an object – a ball or a book in his hands or
    ask him to interlock fingers.
iv. While bending down, allow him to bend knees slightly if he has difficulty. If he cannot stand,
     allow him to sit on a stool chair and then bend.

Eg.2. Trikonasana
This asana involves twisting to one side. It helps in bilateral balance.

Here, the student is required to extend one leg forward, twist body and bend to one side, which may be difficult. Turning the foot which is forward in the direction of the body will help.

Eg.3. Paschimatanasana

This involves the following steps.
i.  Sit straight with legs extended.
ii. Raise hands above head.
iii. Bend forward.
iv. Touch toes.
v. Slowly come back to sitting position.

Provide support of wall for those who have difficulty in sitting straight. Allow them to bend knees slightly if required.

Eg.4. Dhanurasana

i. Lie prone on floor.
ii. Raise hands backwards.
iii. Raise legs.
iv. Hold each leg at the ankle with each hand.
v. Maintain this posture for few seconds and release.

Allow them to raise one leg and hand at a time and introduce counting at each step. This may be taught for children who are high functioning.
Alternate counting by student and teacher will help maintain student interest. Counting aloud while bending forward also facilitates exhalation.
Let children practice one or two asanas at a time repeatedly. After 15-20 minutes of practice let them rest – prone on the floor.
Take support of trained yoga teacher and learn aasanas well. Let the teacher teaching children. Consult the teacher for modification so that you don’t make a mistake.

PLAY

Definition of play:
As defined in “Adapted Physical Education and Recreation” by Sherrill, play refers to the spontaneous, pleasurable behaviours through which children interact with their environment. In non-disabled children, play is inborn and instinctive, and they progress through easily observable stages right from exploring and manipulating the environment during infancy to grasping complex rules, strategies and regulation as in competitive games, when they grow older.

Most children utilize their time outside school in unorganized or structured play activities. They are attempting to use play as a constructive activity and an outlet for excess energy. Earlier theorists proposed four major explanations of play. The first was the surplus energy theory (Schiller et al, 1875). According to this, the reservoir of energy left over after the basic needs of the body such as food are spent on play.

The second is the relaxation and recreation theory of play, proposed by philosophers Lazarus (1883) and Patrick (1916). In contrast to the first, this theory proposed that after engaging in physically and mentally exhausting work, the body is drained of energy and needs sleep. However, in order to achieve full restoration, it first needs to engage in play activities, that help one relax and release pressure.

The third is the practice or pre-exercise theory of play (Gross, 1898, 1901). The purpose of play according to this theory is to practice skills necessary for adulthood.

These theories influenced formulations of contemporary theories of play, which can be categorized under (a) Piagetian, (b) Psychoanalytical and (c) arousal theories.

Piaget focused on cognitive development and interpreted play in terms of its relation to the development of knowledge. The four major stages of development are:

1.     Sensory motor stage (0-24 years of age): Children discover properties about objects around them by engaging in organized patterns of behaviours (schemes).

2.     Preoperational stage (approximately 2-7 years of age): Thinking in this stage is intuitive and illogical.

3.     Concrete operational: At this stage, thinking is in terms of operations, primarily at a concrete level.

4.     Formal operations (12 years and above): Abstract thinking and problem solving begins here.

At different developmental stages, children engage in different qualities of play. Practice play occurs during sensory motor stage. Body movements in new born babies are reflexive, and involve no interaction with outside stimuli. Around 4-8 months, babies will discover a relationship between reflex action and outside stimuli. For eg. If a baby kicks and the milk bottle falls, she will repeat the action to see the bottle falling. As a consequence of this knowledge of cause and effect relationship, she begins to engage in more and more of such behaviours. Through trial and error, she is beginning to learn more and more about the world. At the preoperational stage, the predominant quality of play is symbolic (one thing represents something else). From here, child moves from solitary play such as pretending the chair she is sitting to be a scooter, to parallel play (preschool age). Here, she may play with the same toys sitting next to others but not interacting initially. Finally, cooperative play emerges, which is related to mastery of language, which in turn facilitates social interaction.

The third category of play which involves rules, emerges during middle and later childhood. Play becomes more competitive and abstract. It is not first about having fun but winning. Generally, it is believed that children with mental retardation also progress through same stages of development as above but at a slower rate. On observation, it is found that these children do not usually interact with toys in the same way as the non-disabled peers. Symbolic play in particular seems to be absent (Barnett et al, 1985). A similar finding has been noted in children with autism (Rutter et al, 1978, 1982). However, there are exceptions as in case of many high functioning children with Down’s syndrome. These children are excellent mimics and have been observed engaging themselves in pretend play such as miming sequences seen on television and using one set of objects as symbols for a variety of other play activities.

Organizing play activities for children with mental retardation
To help children with mental retardation, learn how to play and enjoy playing, a teacher needs to keep the following points in mind.

Activities
Pre-school level

Any old cardboard carton will serve as a wonderful play area for an infant. Suspend variety of objects at different heights and observe child at play. This is extremely useful in teaching children with severe/profound mental retardation to communicate. For example, when he shakes a rattle, provide food. When this process is repeated, over a period of time, he learns to relate shaking of rattle to hunger/getting food.

Models of vehicles (pulling and pushing type) and ball can be used to encourage interaction with others. In the classroom, organize play corners. Arrange sets of play material at each corner. Tell them `children let’s go on a bus ride. As we stop at each place, take a look around. Choose a place of your liking and play there’.

Depending on their availability, each corner can have kitchen sets, musical instruments, water play items, sand or clay, blocks and beads. Through this, you will be developing their abilities to imagine and make choices. Observation of children at play will help you assess their abilities and talents.

You can use old newspaper for a variety of play activities as given below:

In the playground, provide a variety of material such as swings, merry-go-round, slide and see-saw. This will help develop their gross motor skills of jumping, climbing and balancing. You can make your own outdoor play equipment using used truck tyres, rope, cardboard boxes and planks, and chairs/tables of different heights. Make sure the material does not have sharp edges and is safe to handle.

While planning:

Use board games such as puzzles, `snakes and ladder’ and carom to develop group cooperation skills. Before beginning – ask child to say `my turn’ by pointing to self or verbally. This helps in teaching child his name and names of his friends, waiting for turn, and cooperating. By asking two children to fit a six piece puzzle together, you will be helping them learn the concept of sharing. Think of more games where children will need to share toys and wait for turn.

Moral/sportsmanship development
While children without disabilities generally understand simple game rules by the age of 4, children with mental retardation lag behind in readiness for organized games. They exhibit conceptual rigidity in playground behaviour. This is often misinterpreted as bad sportsmanship. Generally, children from four years of age to adolescence tend to regard game rules as sacred and absolute and are taught that obeying rules is a part of good sportsmanship. The motivation for obeying rules follows a definite developmental sequence. Table-1 presents stages in moral development as proposed by Lawrence Kohlberg.

 

5.5 Therapeutic intervention: Visual and Performing Arts (eg: Music, Drama, Dance movement, Sports, etc.)

There have been many instances where children have fared average or below average in academic subjects but excelled in sports or arts or music. It is now recognized that there is more to preparation than just academic learning. Bright and Mofley (1977) stress that the ultimate test of our educational system pertains to its effectiveness in assessing students to have a well balanced emotional and intellectual life that includes leisure participation.

Educators are beginning to realize that creative activities not only help develop individual potentials and talent, but enhance learning certain academic concepts. They are interesting, fun to do and experiential. How many of you can remember learning information through a relaxed conversation than through drilling or lecture method? The same implies to children. Learning becomes enjoyable, and there are opportunities to enhance their skills in language, motor abilities and socialization.
Activities such as music and dance, crafts, sports and games and other physical exercises and computers are now being included in the regular timetable. They are now referred to as co-curricular activities. Trained teachers in each one of these areas are appointed and children given a choice to pursue the activity of their interest. In case of children with mental retardation also, the importance of co-curricular activities in their growth and development is well recognized. Many educators have realized that their education must extend beyond the environment of the classroom. Most of them have a disproportionately large amount of leisure time when compared with their non-retarded peers. If they do not acquire skills to utilize their leisure time meaningfully, the problems will be compounded as they grow up. Also, as in the case of all children, creative activities may enhance their learning of academic skills, improve self-image and provide avenues for vocation.

Howard Gardner lists 7 intelligences namely, 1) linguistic intelligence, 2) musical intelligence, 3) spatial intelligence, 4) bodily kinesthetic intelligence, 5) analytical intelligence, 6) interpersonal intelligence, 7) intrapersonal intelligence. He urges the trainers of children with learning problems in academics to look for other abilities in them. Bodily kinesthetic intelligence reflects in performing arts (dance for instance) and games and sports. Musical intelligence is seen in some of the mentally retarded persons with even moderate degree of retardation, excelling in Tabla, Guitar or vocal music.

VISUAL ARTS 

What are Visual Arts?
Visual arts include all those activities, which involve use of a variety of materials of different colours, shapes and textures in the environment, to create something that we use or admire and/or appreciate. These creations may be of aesthetic value – to be admired as art objects or of some use. The common media through which visual arts are expressed are painting, craft, sculpture, needle craft, weaving and pottery to name a few.

How are they useful?
All children like to take pride in what they have created on their own and look forward to praise and admiration from others. Similarly, children with mental retardation also have the ability to create, take pride in and be admired for their creativity, provided the tasks are broken into smaller steps and are given more time and assistance.
Involving them in creative activities will enhance their visual perception, fine motor co ordination, and improve attention and concentration. These will give an opportunity to develop appropriate social skills.

How do you plan your activities?
It is very important to plan the method of processing each activity for children with mental retardation. The teaching situation should have more visual, auditory, tactile, kinesthetic involvement and less abstract commands.

Visual cues: When introducing a new activity, demonstrate it first, so that the child sees what participation would be like. Demonstration is very valuable to communicate the nature of the activity as well as in serving as a model of appropriate behaviour.

Auditory cues: Repeated verbal explanation, and simple step-by-step instruction in the activity communicate information and feedback to the student.

Tactile cues: The activity to receive information through the sense of touch has proven invaluable for children with metal retardation, specially so, for those with sensory impairments.

Decide on materials needed, style of presentation, stages of presentation and student involvement before you begin. Be ready with alternatives if things do not go as you planned. Do not make the children wait. They will be distracted and motivating again will be difficult.

Activities We shall now see how activities can be carried out for specific groups of children, keeping in mind their functional abilities, developmental level and degree of retardation.

Pre primary level
The age range in this group is generally between 3 to 6 years. At this age it is important that children play and enjoy themselves and hence conduct activities in a friendly and informal atmosphere. Collect a variety of materials from the environment and make sure that they are harmless, nontoxic and easy for children to handle. Activities suitable for this age would be paper tearing/ rolling/ crumpling, pasting, finger/hand/foot printing, colouring and spray painting, clay modeling and printing with moulds such as leaves, vegetables, cotton or sponge. As a creative teacher it is important that you plan each activity well in advance by following these guidelines.

Sample activity 1: paper craft

Materials: Newspaper, wrapping paper or colour paper and gum.

Give each child a sheet of paper and ask her to tear it to pieces. Apply gum on another sheet of paper and ask her to paste the pieces on it. Alternatively, ask the children to crumple them and paste. Draw any figure around the pasted pieces, or let each child paste inside a drawn figure. Break each task into smaller steps and teach.

Here is how you can break the task into smaller steps:

Hold the child ‘s hand and guide through each step or wherever required telling her in simple sentences what to do. Repeat instructions and praise every attempt.

Use brightly coloured paper to motivate them to participate.
Try pasting other materials such as dried leaves or flowers, cloth or seeds.

Sample activity 2: Printing
Materials: water colours, paper, pieces of vegetables such as potato, ladies finger, carrot, or leaves or coconut fiber.

Give each child a sheet of paper, wet sponge, wet sponge with paint and any one of the above materials. Ask him to dip the piece of vegetable in paint and press it on paper. Sequence the task as shown in task analysis earlier. Initially, let children dip their fingers/palms/ foot in paint and print. Display their creations.

Sample activity 3: Clay modelling

Materials: potters clay/ mud/ plasticine/ play dough
Make sure the above material is smooth and free of stones or twigs. Allow each child to handle it and make his own shapes. Demonstrate making a few models and let children make similar ones if they can. Do not insist that they make exact replicas. Ask them to name what they have created. Make your own play dough….. Make your own play dough by mixing 1 cup of flour to 1 cup salt. Add water and 1 spoon oil and colour powder. Some children may be hesitant to work with clay. Before introducing activity, give repeated practice of squeezing wet and dry sponge, rubber balls, hinge sound making toys and other materials of different textures. Parents could help them practice at home by also asking them to knead small amounts of dough.

Use creativity and add more activities.

Primary level
Children at this level usually have a basic understanding of names, colours and type of materials that they use. Let the group choose what they want to do – provide required materials and give a specific topic for creation. Children with severe mental retardation may not be aware of the above concepts but it is important that you create an environment which allows them to participate at their own level in each activity. For example, if the activity is paper tearing, allow the child to hold it in his hand and manipulate it in his own way. Make a small tear at the top edge, help him to hold it with his thumb and fingers and tear the paper completely. Give him more time and provide physical guidance till he does it on his own. Children with mild and moderate mental retardation will be able to work on given topic, provided the activity is demonstrated initially using clear simple instructions.
Activities suitable to this group include painting, colouring, making collages, clay modeling, needlework, cutting and pasting. Creative activities can actually be an extension of academic lesson taught. For example, if you have done a lesson on vegetables, let children cut and paste pictures of vegetables, draw and colour vegetable figures, or make clay models of vegetables. By doing this, you will be reinforcing their learning, provide visual, concrete experiences and make learning an enjoyable task.
By working in groups, they learn to share, co-operate, wait for turn and appreciate each others work. Initially let them make their own creations Later give them specific topics to work on, depending on their abilities.

Example: draw/ paint flowers or scenery, draw a picture of celebration of current festival/ seasons, make models of fruits/ household objects/ animals and birds.

Allow them to choose their own colours. Ask them ‘ do you want red or blue’. If they have difficulty in choosing, provide cues like ‘ look at this green ball – choose a matching colour’
There may be some children who can draw simple figures such as sun. In such a case, draw outlines of a simple scenery, without a sun. Ask child to draw the sun and colour the picture. This provides a sense of achievement in him.

Some children may know how to draw basic shapes very well. Guide them to make interesting figures using a combination of few shapes.

Sample activity: Making a collage

Materials: Wool or colored thread, pieces of cloth, gum, paper.

Activities at Secondary/Prevocational level
As in Primary level, here too, children are aware of basic concepts of colour, shape and texture. Creative activities could be used as a means for developing hobbies or leisure time activities or as vocational activities. There are many ways in which you can train them to develop and use appropriate social skills, such as;

Activities such as painting on pots, weaving and stitching, embroidery, bead work, fabric printing, could be developed into vocational skills as they grow older, which will not only develop their creative potential but also contribute towards making them as independent as possible by becoming wage earners.

Activity 1
Stitching: Many children good at embroidery and weaving. Readily available cross stitch cloth with simple designs printed and colours indicated can be used to teach them embroidery.

Some of them may require simplification of the process. To introduce stitching, punch holes in a cardboard at even intervals. Give each student a long shoelace and ask her to bring it in and out of connective holes, line wise. Next, provide a large needle and firm cloth.

Draw straight lines on the cloth in contrast colours. Let the student practice repeatedly.

Activity 2: making letter pads
Materials: plain paper, paint, crayons, card board
Take a plain sheet of paper. Cover it with cardboard, leaving ½ -1 inch paper at the bottom edge. Let the child color it with paint or crayons. In this manner, prepare as many sheets as required. Bind them together. Take two plain sheets and let children do finger printing on it. Use these as front and back covers. Your letter pad is ready!

There may be students who may not be able to hold a crayon or brush. Ask such a student to press the side of his palm in point and print on paper.

Activity 3: Making Placemats
Materials: Small pressed leaves and flowers, cardboard of chosen colour, lamination facility.

Cut cardboard/thick paper in the size of dining table placemats. Paste pressed flowers and leaves artistically on both sides. Laminate both sides. All these can be done by the retarded youngster – right from pressing leaves and flowers to laminating. Each set of six when sold will fetch him his pocket money!!

PERFORMING ARTS

Performing arts are a means of expression; of ideas, concepts, thoughts, opinions and abilities, through drama, dance, movement and music. Performance could be through any one of the above media or a combination of two or more.

Importance of performing arts for children with mental retardation
Right from infancy, children listen to music, enjoy making movements to music and listening to stories, especially if they include action and voice modulation. Traditionally, we have had the privilege of enjoying listening to verses/stories/songs narrated by our grandparents- drawn from our rich cultural heritage, across all religions. Mentally retarded children are no exception to them. Broadly, teaching of performing arts benefit children with mental retardation in the following ways.

It is well known that fables featuring animals and supernatural characters such as Panchatantra, Hitopadesha and Aesop’s fables have been repeatedly used to educate children who were labled slow or dull. Recently, various dance forms and playing musical instruments are being tried to reduce hyperactivity. World over, music, dance and drama as therapies are becoming a part of remedial education for children with developmental disabilities. Specific methodologies, are used for set goals according to needs and evaluated.

Children with mental retardation can be taught to appreciate as well as perform these activities, provided they are taught.

Use of performing arts helps you establish a close rapport with children, handle large groups and make learning enjoyable and teaching less tiring for you. According to the age level, you can teach them a variety of activities such as clapping hands, simple rhythmic movements and miming to complex dance forms, singing or playing musical instruments and drama. They contribute towards individual’s overall development and build/improve self- confidence.

As mentioned earlier, it is important that the right cues – auditory, tactile, visual or kinesthetic be selected while planning, depending on individual needs and abilities. Cues should be gradually faded to facilitate independent participation. For example, physically guide a child to do a hand movement in a dance rather than saying right/left, which is abstract. Gradually reduce support and introduce the music.

Activities
Let us now see what kind of activities can be taken up for children at various levels of functioning.

Pre primary level
Children at this age enjoy rhymes and rhythm and dramatized stories, especially those involving animal characters.
Sing nursery rhymes along with actions to

Sing or play recorded music and encourage children to move rhythmically or in whatever way they can. According to their abilities, they could do whole body movements, wave hands, shake legs or tap feet or just move their heads. Playing on a percussion instrument is reported to calm down aggressive children. Identification of words fast/slow, loud/soft, high/low can be taught using drumbeats or just by clapping. Allow those children who are shy, just to watch others initially. Gently draw their attention to what is happening. A large mirror in the classroom is a great idea to provide visual feedback, to enable children to see what they are doing, imitate and admire.

Here are some rhymes/songs, which are fun and educative at the same time.

For teaching parts of the body use……..

“Head shoulders knees and toes”
“Clap your hands
tap your feet…….”
Chubby cheeks…..”
“Put your right hand in…….
Do the boogies Woogie…..”
“Here we go round the mulberry bush”

can be used to teach concept of daily routine.

Develop your own rhymes in the local language, which are more culture appropriate and understandable for children.
Draw basic shapes of circle, square and triangle on the floor and guide children to move on the outlines to the accompaniment of music.

Exaggeratedly mime activities of daily routine and let children observe and imitate. Name each activity. Encourage them to name.
Make use of masks and puppets and dramatize familiar stories in 3-4 sequences. Let children wear the masks and observe themselves in the mirror.

Activities for older children Musical activities: Children at primary/secondary levels learn various concepts under environmental studies, social studies, mathematics and science. You could use popular folk tunes or film tunes to create your own rhymes to help them learn the above concepts. Using song form makes learning interesting and enjoyable and helps children to recall what they have learnt quickly.

Rhythmic clapping or drumbeat can be used to teach them to count, identify loud and soft sounds and concepts of faster and slower. Ex: say the number three and ask them to clap thrice.
Sing the seven musical notes and ask them to repeat each sound after you, sustaining each note. This may help to enhance verbal communication.
Sing or play a tape of popular songs. Let them listen and repeat. This could be used as an activity reward for having completed a given task.

Older children may be taught folk songs in their regional language.

Dance activities

Initially, let them form a circle, hold hands and move to music, clockwise and anticlockwise. This will help in warming up. Encourage group participation.

Slowly introduce movements such as raising and lowering hands, coming to centre of the circle and going back, sitting and standing, holding hands on waist and tapping feet. Tying bells (ghungroos) at the feet will make the activity very enjoyable. Also try giving each child a colorful baton or ribbon to motivate them to move.

Take them out to a local school performance or play a videotape of folk dances – tell them to which region it belongs. Draw their attention to the costumes and make up.
Children enjoy dressing in colourful costumes. Include ‘show time’ in your timetable where children get a chance to dress in dance costumes and wear make-up. This will help them overcome stage fear and increase their self-esteem.

They can be taught formal dance, provided each step is taught in small sequences and repeated. For example – first teach hand movements, then feet and then whole body. Counting 1-2, for each sequence will help them remember the sequence. Once they have learnt the steps, introduce the song.
Some children with severe mental retardation may need to be addressed individually, require physical guidance and told repeatedly what to do such as-‘ Raju, bend down, move your left hand’ and once he has learnt, proceed to the next step.

Drama
Drama can be used to enhance learning of concepts, teach appropriate social behavior, safety rules and hygiene, current events and about our culture and environment. The visual and auditory cues which drama provides improves learning and retention. You can also use drama to teach them express emotions such as anger, fear and happiness.

Activities
Children at pre-primary/primary level learn to name animals, their food habits and their habitat. Their learning of these concepts can be enhanced through drama.

Theme
Example: (A lion throws a party and invites some of his friends over. At the party there is a large table with a variety of food. The lion introduces himself. He tells each one of the animals gathered there to tell their names, where they live and what they would like to eat. Each animal chooses his favourite dish from the table. After eating, all the animals dance and have fun together.)

Appropriate music is played at the background and children are dressed in animal costumes. (use masks if costumes are not available). A large cloth, painted with trees and flowers can be used as backdrop.
Dialogues should be simple and short.

Example: Lion:        I am a lion
                                I live in a den 
                                I like to eat meat 
                                And go hunting at night.

Similarly each animal introduces himself. Back in classroom, encourage discussion on the play. For older children, role-play, pretend play or mime can be used, both as a recreational activity as well as an educative one. While planning, consider the following points.

Select sequences from mythology and popular folklore and teach them to enact. Dialogues could be delivered at the background and children trained to mouth the words or mime appropriately. Also record sounds of children crying, laughing and shouting and use this in the background according to the scene. If children are required to use dialogues, make sure it is in familiar language and short.

Children who have difficulty in walking could be given roles where they require to just sit on a throne or be still as an idol or simple repetitive activities like fanning the king or as ushers.

Children who are fond of moving around may be dressed in animal costumes and allowed to run on stage during a forest scene. Make sure it is appropriate and in context.

During craft class, let children do leaf/finger printing on large sheets of paper. Stick them together and use as backdrop for drama.

ORGANIZING AND COORDINATING VISUAL/PERFORMING ART PROGRAMMERS 

Training the children in visual and performing art activities is one aspect of CCA and coordination of such activities is another aspect. This requires skills in communication, arranging for resources which may be human resources, materials, funds, publicity…. when the children with mental retardation are found talented in certain areas, creating public awareness by organizing, exhibition, fete and shows is in order. This will not only make the public aware of the brighter side of these children/adults, but also improve the self-esteem of the retarded individual.

The various abilities a teacher should have in achieving this include;

1.     Coordinate among trainers and students

2.     Contact industries and public/private sector undertaking to sponsor shows or materials. For instance paper, crayon, paints and other raw material can be sponsored by stationery companies.

3.     Make them realize it is not charity but an avenue to exhibit talents of persons with special needs.

4.     Contact media/publicity persons for good coverage, a person with mental retardation will also like to see himself on T.V. and newspaper.

5.     Get a popular visual and performing artists in your region to actively participate by making them patrons.

6.     In your school, make sure there are regular classes of visual and performing arts and all teachers and students take part. Make a slot in the timetable.

7.     Whenever possible involve nonretarded peers in organizing conducting programmes.

8.     Be in touch with agencies like VSA to know the current trends and make sure your students participate throughout the year, to earmark some occasion and interschool activities in visual/performing arts taken place. Be informed and make use of it.

9.     Always look for an opportunity to organize such activities.

SPORTS

Physical education plays a very important role in helping a child with mental retardation understand his body in (motion) movement and at rest. It includes instructions in relaxation, opportunities for creative expression, social interaction, practice and scope for selecting meaningful leisure time skills. It builds self confidence and improves one’s self-image.

Adapted Physical Education
Definition: Adapted physical education is the body of knowledge that focuses upon identification and remediation of problems within the psychomotor domain in individuals who need assistance in mainstream education or specially designed physical education services. Since adapted physical education is a part of special education, a multi-disciplinary approach is very essential, as each child’s developmental level and needs differ. It gives scope for educators to develop skills in students through assimilation of many disciplines by including lessons in recreational skills, music and dance, art and drama.
Children with mild or moderate mental retardation who have motor abilities similar to non-disabled persons may be trained in physical exercises, sports and games with slight modifications in terms of rules and complexity of the games. Organizations like the special Olympics give them opportunities to exhibit their skills at national and international levels. You will learn more about special Olympics in the next unit. However, children with severe/profound mental retardation in whom physical growth and development are grossly delayed require adaptations and training needs to be done at a sensori motor level.

Sensori motor training
Sensori motor training, which is the earliest form of physical education for children with mental retardation is done in four main areas of behaviour – namely, (a) level of awareness, (b) movement, (c) manipulation of environment, (d) posture and locomotion.

1.     Level of awareness – help the child to recognize pleasant/unpleasant stimuli – exercise discrimination in anticipating or avoiding future contacts. To evolve avoidance reactions, try hot/cold water, vigorous toweling of skin, restraints such as splints on legs and weight, taps from rubber, hammer and extreme tastes such as alum or lemon. For approach reactions, try pleasant stimuli such as bell ringing, music, human voice, colourful objects, cuddling or drawing closer. Also – children are drilled on discriminatory reactions such as responding to name, obeying simple verbal/gestural commands, or turning towards objects when named.

2.     Movement – As the child becomes aware of sensory stimuli, he must be trained to make more motor adjustments. Initially all purposive movements must be initiated by teacher – (carry, rock, roll, bounce, swing the child). Child may begin with active assistance leading to independent movement. Progression –> roll to side, roll to front to back, roll completely over, roll in a barrel, roll over pillows, rock on a chain or hose, bounce on a bed, jump to seat – swing in hammock or trampoline – continue till sufficient muscle strength is developed to allow sitting and standing postures without external support.

3.     Manipulation of environment – This implies teaching – reaching, grasping, releasing, throwing, holding, passing from hand to hand, rubbing, squeezing, tasting, pounding, shaking, pulling apart and deassembling. It also includes communication – through sounds, gestures, words and self help skills with assistance.

4.     Posture and locomotion – start with lifting head, with lying in different positions, motivate by ringing bell or smell food.

Teaching strategies
Eg. Jumping: Students with mental retardation will be able to learn this skill through task analysis. Before teaching jumping, teach children to fall safely from standing position (a prerequisite movement). This could be done using music and movement activities such as holding hands and moving in a circle and falling down, when you say “all fall down”. Also be more creative and show children creatures which naturally jump such as a grasshopper or a frog!

Such children find it easier to jump from a height to the floor rather than from a crouching position, because losing stability from a height is easier than from the floor.

Find different things in the environment from which children can jump.

1.     Jump down from 8-inch step.

2.     Jump down form 12-inch step.

3.     Jump down form 18-inch bench.

4.     Jump down from 24-inch bench.
Similarly, task analyze activities such as throwing, rolling ball, reaching and pulling. Plan on what movement patterns should they possess before doing the actual task? How will you help them learn these movements?

Planning physical education for persons with mild mental retardation
Do children with mental retardation need Special Physical Education programmes?

Such children are capable of successfully participating in regular physical education classes provided placement is done taking into account the physical and motor learning characteristics of each child. Although they may not acquire high degree of skill of children without disabilities, they can acquire sufficient skills to participate in different activities to increase their physical fitness and improve their body mechanics.

Placement should be flexible in physical training programmes. Some may be placed in special classes, others may be placed in regular classes for small portion of every period. Some may be competent enough to be integrated into a complete physical training period. While placing, keep in mind:

How many can one teacher handle at a time?
Physical education teachers should endeavour to maintain a class conducive to learning. The student-teacher ratio will vary according to the motor skill level of the child and the ability of the teacher. One teacher may teach 10-12 students with mild mental retardation at a time. Research suggests that using trained peer tutors can provide beneficial experiences for students (Houston-Wilson, 1993).

But there is not enough space.....
A distraction-free area in a classroom is sufficient to begin instructions, and opportunities should be provided to utilize new skills within larger environment.

Initially student interest may exist but may not be sustained. To reduce boredom, use attractive pictures, music or play equipment before introducing actual activity. Use sitting and moving activities alternatively.

Do we need a lot of equipment?
Yes. A wide variety of play equipment is desirable – enough for each specific activity so that no child need sit around, waiting for a turn. In addition to commercially available equipment, as an innovative teacher, you may explore the possibilities of using many ordinary items such as boxes/cartons, used tyres, barrels and large pipes, rope, tree trunks, boards and planks.

How can we teach them the importance of physical fitness?
Several researchers have concluded that children with mental retardation tend to have low levels of physical fitness. The low levels may be probably due to lack of opportunity and appropriate programs. But, if programmes are systematically developed and implemented, you will see significant improvement.

What activities are most suitable Can they follow rules

Most children with mild mental retardation can participate in regular sports and games, provided they are integrated as early as possible. They must be introduced to recreation facilities available in the community like swimming, hockey, ball games, skating, cricket, athletics, and other sports events. Participation should begin right at primary level so that as they grow older, these activities are channelized into recreational/leisure time activities or lifetime sports. They should be trained to express their creativity, emotions, imitation skills, anger and elation verbally or non-verbally.

These children are capable of achieving success in team games like anybody else, provided systematic training begins early in life.

Children with moderate mental retardation may participate in games with minimal rules such as running, hopping, skipping, aim and throw, jump rope activities and skating, and in team games like hockey, throw ball and cricket but may not follow all the rules. Older children may perform in individual events like track, swimming and gymnastics.

Activities and adaptations

1. Ball throw

Have children stand in a line one behind the other. The first child is given three chances to throw a soft ball to a peer standing at a distance. He goes to the end of the line after 3 attempts. The peer rolls the ball back to the next child in the row. The child who throws farthest or succeeds in reaching the peer is considered winner.

Modifications:
Reduce distance, vary the size and texture of the ball. Place a box or a pot to throw the ball into. For children with associated impairments such as blindness, use a ball which makes noise. Allow children who cannot stand, to sit and throw.

2. Track and field events
To train positioning of hands and feet in place before signal is given for running, mark outlines of hand and foot where the student has to place them. Use brightly coloured flag or a loud whistle for starting the race. Mark the tracks, starting and finishing points clearly. In a relay race, use bright coloured batons. Reduce the distance for children who have difficulty in running.

3. Wall ball (Primary level)
Divide players into groups of six. They stand in lines perpendicular to a wall, four feet apart. Mark distances every foot, three to eight feet from the wall. First child in each row throws and catches the ball off the wall three times. He then moves to the next mark and repeats throw and catch. If he misses, he goes to the end of the line and the next player gets his turn.
The team where all members finish are winners. A player who completes catches at each mark has finished playing. Others repeat the throw and catch at the point where they missed previously.

4. Balancing activities – book balancing, balancing on beam
If the child has limited balance,

5. Jump rope activities

6. Target activities
Stack empty tins like a pyramid manner. Give each child three chances to aim and hit the tins. Ask others to count the number of tins fallen. Vary the targets to be hit. Reduce distance, size and texture of ball if the child has problems in coordination. Provide a backdrop for easy visibility. Place targets at ground level and allow child to roll the ball if he has difficulty in throwing.

For older students – during games such as shuttle, throw ball, volley ball and basket ball reduce the height of the basket or net. Take them out to watch matches between local teams or on television. Organize friendly cricket matches where students can play with neighbouring school teams.

Games in which the student’s disability becomes an asset, provide excellent opportunities for group cooperation. For example, Blind fold all participants and ask them to locate source of a sound. Student with visual impairment may give them cues to locate.

7. Team games
Team games are especially important for persons with mental retardation because they provide opportunities for large muscle activities necessary for maintaining physical fitness. They also enhance their abilities to contribute to the group effort, and of course social competencies.

Cricket is one of the most favourite games in our country. This can be easily taught with few modifications. Some children may need intensive training in each of the these areas before beginning the game. Begin with throwing and catching the ball. To reduce monotony, have two teams stand in row facing one another. Ask the first child in one row to throw the ball to the child facing him. He catches it and throws to the second child opposite. Continue catching and throwing till the end of the row. Reshuffle the order and teams. Alternatively, let one team stand and the others change positions – sit, crouch, lie down and catch the ball. Once they learn to catch, increase the distance between teams.

For training in taking runs, ask each child to choose a partner. Ask the child who has motor problems to be umpire. Provide prompts for calling/signaling a run.

There are numerous games that children play. Select the game adapt if needed and train the students with mental retardation using the correct blend of creativity and teaching principles.