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Disclosing the action : Activities of Daily Living and the Blind Child
UNICAMP –State University of Campinas,
CAMPINAS,
SAO PAULO
BRAZIL
Email: Sonia.arruda@terra.com.br
ABSTRACT
Activities of daily living (ADL) are daily routine actions that play a prominent role in the lives of blind children. As loss of vision restricts spontaneous learning of ADL, this study was conducted with blind children aged between 4 to 10 years at a university center for rehabilitation.
An analysis, based on the piagetian theory, was performed of the physical, social and mathematical logics involved in the act offhand washing. An analysis was also conducted of the main instruments, techniques and strategies for teaching and learning ADL. This study reveals a new perspective of ADL that favors not only the acquisition of independence and autonomy of the visually handicapped child but also broadens the child’s knowledge resulting in social inclusion.
The results of this study permit an analysis of these activities and the application of this methodology by professionals as well as parents of visually impaired children. Children without any visual impairment may also increase their knowledge through ADL. A blind child’s quality of life is enhanced by the execution of ADL that contribute to the individual’s formation and development.
TITLE:
Disclosing the action: Activities of Daily Living and the Blind Child.
UNICAMP –State University of Campinas,
CAMPINAS, SAO PAULO, BRAZIL
I- INTRUDUCTION
Visual impairment is graded from low vision that corresponds to a visual acuity of 0.03 - 0.1 in the better eye to blindness with a visual acuity of 0.05 that goes up to total absence of luminous perception. It is characterized, after surgical or optical correction, in cases where both eyes are affected, by alterations in the ocular structure or brain (CARVALHO, ET AL, 1996; ALVEZ; KARA-JOSÉ, 1996).
Therefore, a child with low vision may use residual vision for reading and writing as well as for activities of daily living, guidance and mobility. A blind child may perceive luminosity but is not visually able to discern the origin of the light that is projected. The child when reading and writing uses just the sense of touch - the Braille system. Nevertheless, the child may use luminous perception together with the perceptions obtained through the other sense organs as a resource for spatial orientation, mobility and execution of activities of daily living.
Activities of Daily Living (ADL) are daily routine actions and include activities related to personal and environmental hygiene, clothes, food, preparation of meals, housework, sewing, gardening, small domestic repairs. These activities also include those outside the home designated as activities of practical life (APL) such as activities related to banks, post office, shopping, restaurants. Many leisure activities are included in the external environment (ARRUDA, 1999).
A visually impaired child may present difficulties in the performance of ADL as a great deal of vision is required. It is very hard for a visually impaired child to spontaneously learn to perform ADL when compared with a child who is not visually impaired, especially because visual imitation of various actions as well as an understanding of the situation is not possible. The child needs contact with the objects, to experiment, feel and hear how the actions are performed before understanding them.
A visually impaired child learns the ADL by integrating the other senses, adapting procedures and techniques. The child uses the other senses to interact with objects that are part of the daily routine and learns how to use them, acquires knowledge, mentally elaborates and represents the events (OCHAIATA, E. et al, 1988).
An important characteristic of learning and practicing ADL is that besides acquiring independence and autonomy, the blind child can construct, broaden knowledge and also develop (ARRUDA, 2001).
The purpose of this study is to analyze the type of knowledge and developmental aspects involved in the hand washing activity. An investigation was conducted about the concepts and skills that may be developed by visually impaired children when performing this activity as well as the resources and learning / teaching processes that could be used. Learning ADL could be a bridge to knowledge and a source of social inclusion for these children.
II- PRESUPPOSED THEORIES
On analyzing the sub-adjacent mechanisms in the construction of mental structures using presupposed piagetian theories, we found a bases for understanding an individual’s process of thinking, acting and obtaining general knowledge. According to JEAN PIAGET (1977) all knowledge is linked to an action because knowledge is built by the interaction of the individual with the objects in the environment.
The objects of human knowledge are people, things, living things in nature, culture, values, history. As the structures of knowledge evolve, new and more ample relationships are built between the individual and the object. According to the piagetian theory there are three types of knowledge: physical, mathematical- logical and social, whose cognitive, affective, social and motor aspects have to be developed.
During the different stages of development, various environmental sources of development result from experiences in learning and daily activities. Physical experience occurs when a child reacts with the objects extracting knowledge and mathematical-logical experience, creating and introducing relationships among them in reflexive abstraction. This cannot be taught but is built by the child (KAMII, 1993; MANTOVANI DE ASSIS, 1999a).
When a child picks, drops, rolls and reacts with the objects, he discovers their properties and establishes a relationship between them(KAMII; DEVRIES, 1992).
Building social knowledge is a result of the concordance among individuals based on social consensus such as rules of moral conduct, laws, values, ethics and the language system. It is an arbitrary knowledge that depends on the social environment and the period during which knowledge is integrated to the individual’s own concept of the world.
A similarity exists in intellectual, social and affective development because actions, motivations and comparisons are linked to intellectual functions. The construction of intellectual structures is a condition for moral, social or affective development (KAMII; DEVRIES, 1986).
The right social environment for the child’s development also favors the acquisition of various kinds of knowledge. From this point of view, the ADL are not only activities that are fundamental and necessary in the daily routine but are spaces to build knowledge.
It is extremely important that the activity is well learnt by the educators, so that the child is given the opportunity to be active and make his own discoveries, acquiring independence and autonomy.
III- METHODOLOGY
This is a descriptive study that uses a qualitative approach. According to CHIZZOTTI (2000), the researcher plays an active role in this kind of study based on the fact that knowledge is not reduced to a batch of isolated data connected by an explicative theory. An observing individual is an integral part of the process of knowledge and interprets the phenomenon, giving them meaning.
The objective of this study are the ADL “ an object is not an inert and neutral thing; possesses significance and relationships that concrete subjects create with their actions” (Ibid, p. 79).
ALVES (2001) states that exploratory activity is not an end in itself but investigates the real, because it is from the real that material can be obtained to construct the possible.
Based on the observation of the case studies attended at CEPRE (Research and Study Center for Rehabilitation “Prof. Dr. Gabriel de O. da S. Porto”, Faculty of Medicine, State University of Campinas, UNICAMP, Brazil) from the 1997 to 2000, an orientation tool was elaborated to teach and learn about ADL, which was part of the thesis presented for the Master degree (ARRUDA, 2001).This study was based on PROEPRE- Program for Pre-school Education[1].
The criteria used for selecting the participants of this study were: children who were already receiving attention regarding ADL at CEPRE; carriers of congenital blindness or loss of vision up to the age of 3 years and to be in the age range of 4 to 10 years. Once a week, the subjects received individual attention or in a group. The sessions lasted for about half an hour and a large part was video-taped.
An analysis of the cognitive aspect of ADL and the physical and mathematical-logical knowledge that should be utilized to acquire the objectives are listed below:
These acquisitions may occur when the child has an opportunity to wash his hands. The affective, social and motor aspects are interlinked with the activity and may be generalized to other activities (Annex).
IV- DISCUSSION and RESULTS
The core of this study is that knowledge can be acquired through the performance of ADL. The cognitive aspect was dealt with to understand how the ADL could favor developmental conditions for a visually impaired child and extend the manner of working with these activities. An analysis of the results indicated that the activity of hand washing, as well as the other activities, can be used to work with different types of knowledge and developmental aspects. The orientation tool supplied the educators with guidance, contributing towards the amplification of working methods and the comprehension of these activities.
It has been verified that different age groups of visually impaired individuals demonstrate their dependence regarding basic activities, especially those related to personal care, eating and dressing. Those with congenital impairment are more dependent because they are blind and depend on others who can see to provide them with information about the environment, people, situations and objects.
What is considered as a normal dependence during the first years of life may extend into adulthood, even in the case of those who have low vision and physical as well as mental conditions to perform the ADL, independent of age , academic performance or socioeconomic situation.
It is important to draw attention to the fact that even many of those who have a high educational level (high school or university degree) demonstrate accentuated dependence with regard ADL., for example- eating , dressing and hygiene.
Therefore, as a blind child cannot spontaneously and naturally learn the ADL like any normal child, it is of great importance to verify the opportunities of intellectual development during a period of life when lack of adequate motivation may seriously affect the child.
The desire to contribute towards helping individuals with visual impairment not only learn to do but to understand the reason for the action as well as to learn and generalize the application of knowledge to other activities, made us take up the challenge of drawing up new pathways.
An important factor is to help the child get to know the objects to be used in the activity. In the hand washing activity, examples should be given of some of the objects that can be used in the activity as well as others that can be increased in size, shape and capacity.
HAND WASHING |
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ESSENTIAL OBJECTS |
COMPLEMENTARY OBJECTS |
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Wash basin and tap; soap case; toilet soap; towel rack; towel; paper towel; bin. |
soap: creamy, glycerinated, liquid; soap bar, soap powder; cold, hot and room temperature water; Kitchen sink, clothes tub, wash basin with automatic tap; plastic toys. |
Another important aspect for a visually impaired child is to learn the sequence of objects. A child who cannot see has greater difficulties in performing an action that he has not visualized before. The child learns through experimentation and is able to perceive that activities have a sequence ( the beginning, middle and end) and the actions performed have a consequence (ARRUDA, 2001).
PIAGET (1987) explains that this relationship is not an automation of acts that define a causality –an organization of the universe as a result of the relations established by action and representation between the object and the subject.
After understanding the sequence and consequence of actions used in an activity, the child is capable of creating new and interesting situations.
A possible activity sequence is presented below:
HAND WASHING SEQUENCE |
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1. Localize the room in which the activity will take place. 2. Localize the wash basin, tap, soap, and towel rack, paper towel supply. 3. Open the tap. 4. Regulate the flow of water. 5. Wet the hands. 6. Localize and use soap in soap tray.
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7. Soap the hands. 8. Replace the soap in the soap tray. 9. Rub the hands. 10. Rinse the hands. 11. Localize and pick up the towel. 12. Dry the hands. 13. Throw the paper towel into the bin, hang up the hand towel on the rack. |
A visually impaired child should be motivated to utilize the other senses to acquire the skill and to understand every situation that takes place in his environment (FERREL, 1996). Therefore, when a child comes in contact with different objects of activity, the child learns to judge whether the tap water is cold or hot, whether a lot of water is flowing, if the soap is small and light and has a smooth texture. The child establishes relationships with the object, his perceptions, the actions he performs and the results. Interacting with the objects, the child builds up his knowledge and learns.
The child feels the movements that the educator (an individual from the family, the teacher or therapist) performs with his hands, perceives and hears an explanation of the action. Very often, the child feels the need to “ see in his own way” or rather feel the movement, understand the movement and then create his own manner of performing the action.
The child individually builds his autonomy and morality during activities of daily living from inside outwards. The child does this by understanding and choosing, not through coercion. According to the piagetian theory, a young child is heteronymous (controlled by others) and becomes autonomous (self controlled) depending on the way adults relate with the child and influence him, especially during the early years, as “the measure by which the adult encourages the child to think for himself, his possibilities of becoming autonomous increase in the same proportion” (KAMII; DEVRIES, 1986, p. 57).
Children must learn to respect and cooperate, be kept in an environment that is rich in requests that arouse initiative and curiosity (MANTOVANI DE ASSIS, 1999b). As ADL are actions that mobilize various sources of knowledge, these activities could offer structures that are able to assimilate and accommodate specific content, considerably influencing the development and performance of visually impaired individuals in daily living.
With this study, we hope to reveal information based on theories that we believe may contribute towards changing the view that professionals, students and family members have about ADL being merely a technique and provide them with a better understanding of ADL along with opportunities for teaching and developing visually handicapped individuals so that they can become independent and autonomous participants, who are confident of themselves and are emotionally as well as socially adapted to the society in which they live.
However, the range of applications of this study is far greater if it is to be used for visually impaired or low vision adolescents, adults or even the elderly. In these cases, attention would be focused on improving the use of residual vision along with that of the other senses.
The proposed approach may also be used to improve the quality of life of children with other kinds of deficiencies as well as for normal children.
According to DELVAL (1998), “the school should not serve to produce submissive individuals or just provide concrete knowledge, but its function should be to favor the social and psychological development of the child, contributing towards the formation of free and autonomous adults in society” (p. 147).
The family should also stimulate the global development of the child. It is important to get to know and relate with the child from the very first days of its life and take advantage of daily situations to provide not only moments that satisfy necessities but moments of happiness that favor development.
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[1] Program of Pre-school Education. Objectives /activities and content. Organized by : Prof. Dr. Orly Mantovani de Assis,. Faculty of Education – State University of Campinas –UNICAMP.
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