2012-4-17-Have You Looked in the Kitchen Drawer
Seminars@Hadley
Have You Looked in the Kitchen Drawer?
(A Process/Sensory Approach to Rehabilitation)
Presented by
Linda Jones
Moderated by
Shirley McCracken
April 17, 2012
Shirley McCracken
Good morning and welcome to Seminars at Hadley. Thank you for joining us today. Our seminar topic today will be about “Have You Looked in the Kitchen Drawer: A Process Sensory Approach to Rehabilitation Teaching”. I’d like to introduce myself, my name is Shirley McCracken and I will be the moderator today. Our presenter will be Linda Jones who is currently working for the Lighthouse at Big Ben.
She is a vocational rehabilitation specialist providing clients with independent living and job readiness skills to obtain successful employment. Before that, Linda worked at Florida State University and she was a rehabilitation specialist. During that tenure from 1996 to 2008, for four years she ran a seven week summer program at FSU campus for vision impaired teens that attended college. Before that, I had the privilege to work with Linda at Texas Commission for the Blind which is now Division for Blind Services here in Austin Texas.
She was a trainer and a rehab teacher there. Linda also has a master’s degree from the University of Arkansas at Little Rock and she has been recognized for her work throughout the years. Some of her achievements have been she was recognized by the Federal Rehabilitation Service Administration Commissions Award for Excellence in Rehabilitation Education, she was also recognized as the Outstanding Educator from the Florida chapter of the Association for Education and Rehabilitation of the Blind and Visually Impaired. It is my privilege to welcome Linda Jones to our seminar at Hadley to speak to us about “Have You Looked in the Kitchen Drawer: A Process Sensory Approach to Rehabilitation Teaching”. Linda, I’m going to turn the microphone over to you now.
Linda Jones
I want to repeat Shirley’s welcome to you today to this presentation called “Have You Looked in the Kitchen Drawer” and some of you may have signed up just out of curiosity about the title. I will eventually get around to explaining that and letting you know how it’s connected to a sensory process approach to rehabilitation but first I’d like to go over the goal and the purpose of this presentation. It’s also nice to see that there is a mix of professionals in the field of vision rehab and those of you who may be fairly newly blinded and want to get some tips on how to live as a visually impaired person, also, I’m very jealous of all you retirees, especially Armando; Puerto Rico is one of my very favorite places in the whole wide world.
The goal of our session today is for both individuals and professionals. That is that every specialist, even if you’re working with one as a consumer yourself, that every specialist desires that their clients be equipped with a set of skills that he or she can choose from no matter what kind of task the individual wants to perform. So, the purpose then of this training is to introduce to you, for the first time, or to re-introduce you to a sensory process approach of rehab and compare that to a task approach.
Some of you may have signed up for this presentation just out of curiosity about the title and I plan to explain that hopefully in total detail for you a little bit later as we move through the session. It’s exciting to me to see that there is a mix in this room of people who are in the vision rehab session and a mix of those of who may be clients of vision rehab professionals and I’m very jealous of those who are retired from your professions but still interested in learning and participating in Hadley.
I’m going to try to balance what I have to say today between the professional idea and for those of you who are just wanting to learn some new techniques about living every day with a vision impairment.
First I want to talk about the goal and the purpose of this presentation. The goal of every professional is to equip his or her clients with a set of skills that they can choose from anytime they want to do some kind of task; to just go to what I call the “kitchen drawer” and pick out the skills needed for that task. The purpose then of this session is to introduce to you for the first time, or perhaps re-introduce to you to a sensory process approach to rehab and compare that to a task centered approach of rehabilitation.
Before I do, I want to give you a little bit of background about where this information came from. For a number of years I would observe many, many visually impaired people and wonder why some of those people seem to function as if they were fully sighted while others continued to struggle even after they’ve had rehabilitation.
I finally realized that the individuals who were struggling had learned to perform a selected number of tasks while the independent ones possessed a cadre of skills and techniques that they would choose from depending on what the task was at hand. It was as if they went to their skill tool box or to the junk drawer in the kitchen and just pulled out the three or four tools that they needed to perform that task.
So, I became a real advocate for the “kitchen drawer” philosophy. I can take little credit for the ideas that I’m going to present to you today. Most of my ideas actually came from two other professionals; a former supervisor at the Texas Commission for the Blind who actually coined the term, “The Kitchen Drawer Philosophy” and Alvin Roberts in my mind the true genius in vision rehabilitation therapy of the past 50 years.
In fact, my article that was in review in 2004 was primarily based on two of Alvin’s articles and I hope you will dig into Journal of Visual Impairment and Blindness and read both of these. One of them is called The Generic Adaptation to Blindness and the other one is Teaching Transferable Compensatory Skills and Processes to Adults.
For today’s presentation I have five objectives that I hope I get across to you. The first one is definitions of five key words or phrases that most people in the field of vision rehab are familiar with although I might present them in a somewhat different style. Secondly, I will give you a generic list of physical senses that will be defined here as skills. The third objective is to introduce you to the four categories of the Least Restrictive Adaptation Model. Our fourth objective, and this is sort of a little task, you can tell I’ve been an educator for way too long, I’m going to give you a task and ask you to analyze that task and then come up with five senses that you would use as adaptations to perform that task without vision. Finally, the fifth objective is to express the psychological benefits of this model of rehabilitation.
So let’s begin with the definitions. The first word is the word “Process”. It is part of the title; Sensory Process Approach. A synonym of “Process” is “Action”. Process is not a thing; it’s not even a concept. It’s ongoing actions that get us through life with or without a visual impairment. In our case, it is the means by which we as visually impaired people or clients obtain the skills they need to function at home, at work, or in the community; wherever they might be performing daily activities.
The next word is “Skill”. Skills are not tasks. Skills though, like the process, are actions. Skills are the means, the techniques, the physical senses or a combination of these that an individual uses to perform a task. Let me give you a couple of examples. One of those is the auditory sense. Think of the auditory sense as a skill; how might I use that auditory sense? Well, I might be listening when pouring liquids or I might be listening for boiling water so that I can add my pasta. I might use special orientation and grid patterns when cleaning mirror or out in my yard raking leaves.
I might use proprioception in an auditory sense when hammering a nail into the wall and hanging a picture on that nail. All of those are techniques and senses that are used to perform a task with little or no vision. So what is a task? Again, a task is not as skill. Skills are used to perform tasks. But, for obvious reasons, if we don’t have a task to perform why would we need any skills?
The next term we are all familiar with, I’m sure, is “Informed Choice”. How often have we heard that over the past many, many years? Informed Choice allows us to have several methods or techniques for performing the same task. Often times it depends on the environment that we’re in as to which approach we might want to use. But, when doing a sensory process approach to rehab, and thinking about transferring skills from one task to another task, Informed Choice is of the upmost importance.
Let me give you perhaps my most favorite example of what I’m talking about. If you and I are sitting down to have a glass of lemonade, when I pour my own I might use the finger method or use sticking my finger in and using my tactile skill to feel the lemonade when it touches my finger. I doubt that you would want my finger in your glass of lemonade and so I would use the listening method and know when to stop pouring as the pitch changes as the lemonade rises in the glass. So, I would be using there my listening or my auditory skills.
If we were having coffee and I had neuropathy as a result of diabetes then I might be fearful of being burned and so I would want to use a liquid level indicator. I would still use my listening skills to hear it make its beeping sound. The last definition I have is “Least Restrictive Adaptation Model” itself.
What this is, is a generic approach to adaptation that we who are visually impaired or the consumers of rehab professionals can apply to an array of tasks; first thinking about what is the most basic approach to that task. It goes back to Informed Choice, which has a variety of techniques depending on the situation and the individual. We will go over the four categories of Least Restrictive Adaptation a little bit later.
I want to share one more revelation with you that I had just a few years ago. That revelation came to me when I realized that my clients or even I, but I think I was already practicing this, that my clients could go into their toolbox or their kitchen drawer and get out the same skills and perform a variety of tasks. Let me show you what I mean.
The same senses and techniques that are used to apply makeup are used to shave, to clean a counter, to vacuum a floor, and even to mow the grass. What are those skills? Well, there are grid patterns, overlapping movements, space orientation, and landmarks. All of these tasks, those are the skills that it takes to perform them whether they are small on my face or they’re out in my backyard mowing my grass.
This was such a wonderful revelation for me because I realized my clients who were deeply concerned about losing their vision could have a psychological relief if I told them, “You don’t have to learn 300 tasks all over again without your vision, you only need to learn about 25 skills and you can do anything that you want to do.”
The other thing that I began to share with them was that no sighted person does anything with their vision only. Maybe sit in a chair and watch the sunset. Many of the tasks that I performed or that others performed we would be teaching our clients in the toolbox, you can pull out the same set of skills to perform a variety of tasks. Or, you could go to my favorite place, the kitchen drawer, to pull out what you need.
For example, the same skills that are used for putting on makeup are used to shave, clean the counter, to vacuum a floor, and even to mow the grass. And I thought, how wonderful for my clients to know that they don’t have to learn 300 different tasks but just a set of about 25 skills and they could do any task they want to do; what a relief this would be.
The other thing then that I wanted my clients to realize is that no one performs any kind of skills with their vision only. I don’t know anyone who looks down at their feet when they’re driving their car to switch pedals, or at least I hope they aren’t. How many of us would go crazy if we couldn’t use the remote to change the TV channel? I wanted them, my clients, to know and maybe some of you as well, that you’re already using these same skills and you’re eleven senses to perform tasks, it was that your vision was so powerful you did not realize that you were using other skills and other senses.
I want to introduce you to the eleven senses. Some of you may have thought you only had five because we only hear about five. I don’t think I need to review the visual sense, that’s pretty obvious; information goes from the eyes to the brain. You probably don’t have to have auditory sense explained to you; that’s information that we hear or receive through our ears.
Let’s talk about how a client or how you as a visually impaired person use your auditory skills to perform tasks. We’ve already talked about using it for pouring or listening for water to boil; food to sizzle. What about dropped objects? I remember being told to stop when I dropped something, to listen, and then to point in the direction where I thought the object had landed. We did this over and over until I got pretty good at finding dropped objects. I also learned to be able to tell how large a room was just by listening or where to locate a certain thing by some kind of sound coming from that direction. I learned to use a fountain as a landmark or clue when going to certain places or in the hammering example I gave a while ago, when you’re hammering correctly and the nail is going to go in straight, the hammer makes a certain sound. I’ve been told I’m not good at hammering.
What about the olfactory sense? How do we use that sense of smell being able to not only discriminate smells but also flavor? In fact, our sense of taste comes from our olfactory sense. But, I can find Body Works in the mall by recognizing the scents that might be coming from that store. I can tell if something is burning in the kitchen by a burning smell. If I failed to label my spices, then by smelling the cinnamon, then the pepper or whatever, I can find the spice that I want to use in a recipe.
What about our gustatory, or our sense of taste? It’s one of the major five. The primary thing though that it does, rather than taste, is to provide texture, size, and density within the mouth. In fact I just learned last night that the most sensitive receptors in our whole body are in the tip of our tongue. Think about it, without that, how would I know how large something was that I had put in my mouth? Or if it gave me a burning sensation, if I did not have the gustatory sense?
The combination of tactile and movement is known as the haptic sense. We use this often when we’re measuring things or when comparing things that are similar but the size may be different. Touching and then using movement to do the measuring, we’ll talk in a little bit how we might use that in the Least Restrictive Adaptation category.
What about the kinesthetic? This is the one sense that most sighted people use all of the time and do not realize it. It’s what we call muscle memory; it’s what happens when you learn to ride a bicycle and you don’t have to think about it anymore. It’s also what a visually impaired person does in moving around a computer keyboard, chopping vegetables or moving across a room and coming straight to the chair that he wants to sit in.
Another sense is proprioceptive. This is the one I do not have; at least not in my hands. This is when we get information from our joints, connective tissues, and our muscles. The proprioceptive sense lets us know if we’re walking up or down a hill or on a level terrain. It’s also the sense that allows us to carry something level or to hammer. I cannot hammer because I do not know what level means. I cannot screw in a light bulb for the same reason. I even have trouble using a screw driver because of the information I get through my wrist and my elbows.
One of my favorites is stereognosis. This is the ability to identify or distinguish things that are three dimensional objects, telling two keys apart, or telling a key from a paper clip, being able to identify the ketchup bottle from the mustard container or a can of peaches from a can of tuna. This is one of the most common senses as visually impaired people use. This is a sense that needs to be enhanced when working with someone who is newly blinded. It’s what we use when we’re teaching people to identify different coins and so on. The list could go on and on.