Unit I: Self Help Skills

1. Dressing: Removing & wearing – using fasteners – appropriate choice of clothes and maintenance – washing & ironing use of suitable footwear and accessories, social and age-appropriate dressing, privacy

2. Grooming: Tooth brushing – bathing – combing – adaptation

3. Meal time activities: Feeding – eating by self – social behaviour during mealtime – setting & cleaning before and after meals – adaptation.

4. Toileting: Indication – use of toilet – cleaning self and toilet after use maintaining privacy – adaptation, privacy

5. Hygiene & self-care: Nose cleaning - Nail cutting – shaving – Menstrual hygiene, privacy

1. Dressing: Removing & wearing – using fasteners – appropriate choice of clothes and maintenance – washing & ironing use of suitable footwear and accessories, social and age-appropriate dressing, privacy

Dressing skills: Dressing activities include removing and wearing clothes including unzipping/zipping, unbuttoning, buttoning, unhooking and hooking and tying lace/ribbon.

•  Use stool/chair/box (size depending on the height of children) to sit while teaching children to remove or wear pants. For example the child removes pants upto knee level and sits on the stool, or box. He can remove the pants easily without having to balance on one foot. Often children with mental retardation have problems in balancing on one foot and may fall. In case of children with cerebral palsy with mental retardation, this method of teaching is very useful.
• First teach removing of clothes after unfastening (by trainer) and then wearing of clothes. 
•  Use large buttons on shirts while teaching unbuttoning and buttoning of clothes.
• Teach fastening of buttons, zips, hooks directly on self after wearing clothes rather than teaching using frames. If needed, give physical prompt by standing behind the child and extending hands.
• Use stickers/labels already on shirts, banians or pants for teaching identification of correct and wrong side of clothes.
• Use adaptations such as Velcro/elastic bands if children have difficulty in buttoning, zipping/tying.

The students with mental retardation need to learn how to maintain their own clothes. This includes:

• Washing clothes.
• Drying clothes.
• Folding clothes.
• Ironing clothes.
• Keeping the clothes in the cupboard.
• Stitching broken buttons/mending it torn.
• Giving clothes for stitching.

In the school, the teacher can train the prevocational group students by instructing them to: ? Keep the dress neat (by using napkins for wiping).

• Use of apron while engaged in cooking activities.
• Stitch buttons in the dress/mending.
• Iron napkins, towels, aprons, and gradually their dress.

Students during prevocational period should also be taught to select their clothes, for themselves. Hence, the family members can be informed to give them opportunity to:

• Select their clothes for different occasions.
• Dress appropriately to attend different parties and functions.
• Choose dress materials for themselves in the shop.
• Select appropriate seasonal dresses.
• Maintain the seasonal dresses properly to use them when needed.

In class, initiative conversation on above topics and elicit responses from the students.

2. Grooming: Tooth brushing – bathing – combing – adaptation

Brushing: This activity can be taught in schools after lunch to those children who have difficulty in brushing teeth.

• Thicken the brush handle with cloth/plaster/fix a wood handle for holding in case there is a need for good gripping.
• Use mirror as far as possible (standing in front of the mirror) while training children in brushing.
• Initially children may eat the paste. A little paste swallowed does not harm children. Gradually train to spit.
• Give a small mug or glass of water for gargling after brushing teeth.
• Teach children to identify their brush, and paste. Teach squeezing the paste from the tube, as the last step as it needs fine motor coordination. Waste of paste should be avoided.
• Children should also be taught to brush their teeth without reminder as it is expected of any non-retarded child above the age of 6 years.

Bathing skills: Teaching of bathing skills is generally done at home by parents/family members as it may not be possible for teachers to teach bathing skills in day care centers. Inform parents/family members on the following points:

• It is always important to see that children select and take their clothes and towel to the bathroom before they take bath. This activity will help in identifying their own clothes and naming of the clothes.
• Children should be allowed to mix cold water and hot water to check the required temperature.
• Privacy needs to be maintained while training in taking bath and wearing clothes.
• Initially sponge can be used for applying soap on the body to avoid more usage of soap or slipping of soap from hands.
• Use a napkin or small towel fixed to rings at the two edges for cleaning the back for those children who have difficulty in reaching the back with hands.

Grooming skills: Applying oil, combing hair, applying powder, fixing bindi (in case of girls) wearing chappal/shoes are all activities to be taught under grooming. Generally, by the time children are 8-9 years, they learn all the above mentioned activities by themselves through observational learning. However, children with mental retardation need to be taught all the activities using special methods.

• For children, who do not know to identify left and right, fix stickers/marking on the inside of heel of the footwear to help in identifying left and right chappal or shoes.
• Tying shoe lace is a very complex activity. There are variety of shoes available in the market without shoe lace, which can be bought for use. Our aim of education is to train students to take care of their personal needs by themselves.
• Use cloth puff to teach applying powder evenly on face. Encourage children (girls) to use bindi stickers which are easy to fix.
• Select comb with a thick handle convenient to hold convenient to hold for teaching combing hair.
• In case of children with low ability, plaiting hair which is a complex activity may be avoided keeping the hair short where one can use rubber band to fix the hair.
• To teach plaiting hair, follow the sequence:

1. Ribbons of 3 colours fixed on undo grill.

2. Wool of three colours.

3. Wool of same colour.

4. False hair.

5. Plaiting other’s hair.

3. Meal time activities: Feeding – eating by self – social behaviour during mealtime – setting & cleaning before and after meals – adaptation.

In order to practice and maintain the learnt skills, these activities should be carried out at home. Family members can be informed to carry out the activities at home.
By regular practice at home and in school these activities can be made as part of routine activities of the students during pre-vocational period.

Eating: In addition to self-feeding, eating behaviour includes
(a) appropriate manners while eating, (b) serving food to others; (c) arranging table (d) cleaning the table, (e) storing the left over food, (f) cleaning the utensils, (g) giving order for food at restaurant, etc.

Parents can be informed to train the students at home in serving food for self as well as for others. While training, the sequence in serving can be:

• Roti, puri, bread, idly, which do not spill.
• Pickle or chutney, which is not hot (temperature).
• Fried dishes, rice, curry, dal.
  While serving the food, the amount to be served need to be indicated to the students.
  As part of regular activity, the parents can instruct the child to:
• Arrange the dinner table (again non spilling, not hot items first).
• Clean the table after meals.
• Store the left over food in bowls and keep them in storing place/fridge.

During the initial stage of training, unbreakable bowls may be used to avoid possibility of damage of the utensil.

Students should also be taught to clean the utensils. Begin with, simple dishes like plates and small bowls (unbreakable) can be used.

Drinking:

• Use a cup/glass with handles on both sides if the child has difficulty in holding the glass.
• Take one fourth of water in the glass in the initial stages of teaching and later increase the water level.
• Use fruit juice, or buttermilk (in addition to water) while teaching drinking. Child’s choice of drink motivates him to drink.
• Give a small jug/bottle with less water while teaching pouring water into glass for drinking. Eating:
• Begin teaching independent eating with non-sticky food items like poori/dosa.
• See that the children eat chapatti with curry, dosa/idli with sambar/chatni; rice and dall/curry and other items to be eaten with side dish. Often it is noticed that children with mental retardation have difficulty in taking proper proportion of the food along with the side dish. They tend to eat curry and chapatti or rice separately.
• Before teaching the student to mix and eat rice, mix rice and curry/dall and make small balls for student to pick up with fingers and eat. If he needs physically guide by placing your hand on top of his right hand and help in picking. Be behind the child so that your right hand and his right hand are in same direction.
• Tell students what they are eating during training.
• See that you do not serve all the food in the plate at a time. Serve a little. Name the food items. After he finishes the food first served, ask the student whether he would like to be served more food
• Tell the parents to give opportunity to their son/daughter to ask for food and also which item he/she wants. Generally parents serve the rice/chapatti with all side dishes and keep in front of the child, not giving him a choice. Before serving, if we ask the child to name the food items, the child will be able to associate the name to the food item in the long run. It facilitates learning language.
• Eating activity also involves washing and wiping hands, washing plate and glass, tiffin box and wiping table. These activities should also be taught to students as part of training in eating skills.

4. Toileting: Indication – use of toilet – cleaning self and toilet after use maintaining privacy – adaptation, privacy

Toileting skills: Teaching of toileting skills should happen at appropriate time in school and at home.

• Teaching privacy is an important step in teaching toileting skills. Always remember to teach the student to close the toilet door while he uses the toilet. When you are teaching him to remove pants to use the toilet or wear pants after using toilet, see that you teach him with door closed.
• Make an effort to teach him to unfasten. In case, it is beyond the students capacity to learn, use adaptations such as elastic velcro in place of buttons/hooks.
• Some children refuse/hesitate to use the toilet with the fear of falling. You can fix the handles on either side of the walls in the toilet so that the child can hold the handles and sit without fear.
• Washing after defecation, pouring water/flushing toilet, washing hands after toileting are part of toileting skills and to be taught to the students.
• Train independent use of left hand for cleaning after toileting when adult pours water. When he perfects that train in pouring water by himself using right hand. It he can not do both together adapt by attaching hosepipe for use by right hand.

5. Hygiene & self-care: Nose cleaning - Nail cutting – shaving – Menstrual hygiene, privacy

Menstrual hygiene: An important skill to be taught to the girls with mental retardation during secondary/prevocational level is menstrual hygiene. To make the girl independent (as far as possible) in personal skills, lessen the burden on the mother and avoid embarrassing situation, right type of training can be provided to the young adolescents at home. While providing training on menstrual hygiene, take care of the following points.

• Pads, available in the market can be used (If the parent cannot afford, make pad using cloth/cotton).
• Well fitting panties are to be used.
• Two strips of cloth like pockets or elastic strip can be stitched at the lower base of panties (which are to be used during menstruation) to hold the pads in place.
• Dates in the calendar can be marked and the child sensitized to it.
• Too much of exhaustion can be avoided during the periods.

While training in menstrual hygiene, instruct the student to -

• report when there is stain in the panty.
• Change the panty immediately after noticing the stain.
• Insert the pads into the strips stitched in the panty.
• Change the pads when it is adequately stained.
• Roll the paid, put in nontransparent (paper/plastic) bags and throw it in proper place.
• Clean the panty and dry in separate place.
• All the way through, ensure privacy.

Shaving: Proper fine motor skill and eye-hand coordination are important pre-requisite skills for teaching shaving. Following points are to be considered while training.

• Task analysis should be done carefully watching an adult (father/elder brother) performing and then taught with appropriate prompts.
• Use a mirror. Provide assistance from behind.
• If the student has motor difficulties or uncontrolled epileptic fits, it is better not to train in shaving. InN such cases, train them to recognize when it is time to shave and ask for help from adult at home/go to the shop and get done. Teaching him the competency to get the shaving done.