Mealtime Skills

Chapters:

1. Introduction
2. Pouring
3. Serving & Utensil Use
4. Cutting
5. Being Involved

CHAPTER 1: Introduction

SHANNON: Hi, I'm Sue Shannon, and I'm an occupational therapist at Perkins School for the Blind, and our webcast today is focusing on mealtime skills. We chose to do a webcast including mealtime skills because it's... they're skills that we use so frequently — everybody eats, many people eat three times a day — and there's many opportunities at home, at school, in the community for mealtimes to take place and for students to be learning.

Mealtime skills are also an important part of the expanded core curriculum. The expanded core curriculum is the information or skills that are required for students who are blind or visually impaired so that they can be successful, in addition to the typical education curriculum. These skills can be things like daily living skills — taking care of themselves, taking care of their homes, learning to get out and about in the community, in addition to things like just the basics of taking care of yourself, washing your hands and eating meals.

Blind children don't have the benefit of the incidental learning that sighted children have. When they're sitting around at the dinner table, sighted kids can watch their parents or their friends and see how they're eating and how they're using utensils. And we see little kids imitate their parents by trying to pick up and use utensils in a skilled way, and this is very important for their learning. Children who are blind don't have this opportunity to just casually observe and learn, so that these opportunities need to be presented to them in a very systematic and structured way so the students have the opportunity to practice these special techniques so that they can be as successful as their sighted peers.

This webcast also offers a great opportunity for us to use visual demonstration for these skills. Sometimes it's hard for us to convey this information written in book form or in e-mails or phone calls to other schools or families, and we have this great opportunity to show a video demonstration of the skills so that they can hopefully make more sense. We are going to demonstrate a few different skill areas: pouring, serving, using utensils and cutting. And we're going to show a few different techniques for each of those skills and then a few adaptations for students who are on different levels of learning.

I just want to emphasize that there is no one right way to cut foods or to pour a drink for someone who is blind or visually impaired. It's just really whatever works for the student. I think that the students often come to us with their own little techniques that they've made up that's worked for them, and we like to go with that and we can learn from them. This webcast is part of a series on daily and independent living skills and also is paired with a publication on the same topic.

Mealtimes are a very important time for all of us. We eat so many times a day. And mealtimes are often paired with social experiences. We have meals with our friends in school or go out to restaurants, out for dinner. There's a lot of family holidays that are focused around food. Things like even weddings and other parties a lot of times are focused around mealtimes. And so having good social skills, good mealtime skills are important for that social experience. Also, when kids are in school, lunchtime is a very, very important time for that social interaction, and it's really easy to be isolated if you're perceived as a person that doesn't have good mealtime skills. So really, it's really doing a favor to the students to help them work on those skills.

There are many, many skill areas involved at mealtimes, and today we're just going to focus on pouring, serving, utensil use and cutting, but there's also other skills, as I mentioned — social skills, having conversations, good manners at meals and even spatial skills or math. There's just lots and lots of opportunities for learning. I think it's important when you're teaching or even when you're not teaching children — when you're at a meal with a child with a visual impairment — it's important that they're involved and have some opportunity for the observation, the exposure to these skills, and having the chance to observe these adaptive techniques, even if you're not actively teaching at the time, is important for the students to gain some exposure.

So if, for example, you're pouring a drink, the way a sighted person would pour a drink is very different than the way a visually impaired person would pour a drink. So demonstrating the adaptive technique that the child may use later in life would be beneficial for them. It's important, too, to set up the environment so it's helpful for learning.

Organization is very important, especially for children who are totally blind. To be able to predict, to have a predictable environment, one that they can know what to expect and know where to find things can make mealtimes go much smoother. So if you always have the fork on the left and your spoon and knife on the right, to try to keep the setup that way so the students know where to find the utensils when they're struggling to learn. Also, just having a clear pathway maybe from the table to the kitchen would be... sort of invite the student to go back and forth from the kitchen and maybe be more involved in the mealtimes or help to clear the table after dinner. Even simple things like pushing in the chairs after the meal, too, can help with the safety around mealtimes.

If you're walking, taking your dirty plate and a knife to the kitchen, it would be good not to have chairs around to trip over. And just lastly, the involvement again is very important, I think, for the children who are blind, so that they don't just develop the sense that when they get placed at a table at a meal, that food doesn't just arrive in front of them and for their benefit, just to eat and then the dirty things disappear and they have no idea of where it goes. So it's important that even if you're just explaining to the student, your child, as you go along through making dinner or making lunch in a group at school to be able to explain to the student what's going on and to have them just be participating, even at the littlest level, to keep them involved.

CHAPTER 2: Pouring

SHANNON: And now we're going to talk about pouring.

Pouring is a little bit challenging of a skill, because there are so many different containers to pour from. There's milk bottles, milk cartons, milk jugs, all kinds of variety of juice bottles, soda, and it's hard to sort of generalize this skill, because there are so many differences in the bottles that liquids come from. So one thing that's kind of helpful to try is to see if you can pick up a small pitcher that has a pronounced lip or spout, and that's a great way for students to learn to be really successful, to use something that has a very clear and simple method for pouring from. And again, I mentioned before, but I think it's important again to say, when you're teaching these skills, it's very important to provide hand-under-hand demonstration.

When you're providing just... as students' opportunity for observation, to make sure that they are aware that there are these techniques to make it more successful. The first technique we'll demonstrate is using your index finger to monitor the amount of liquid in the glass. What we're going to do is bring the cup up to the spout and find the spout with your index finger. Try to keep your finger on the outside of the spout so that you don't get your fingers inside where the drink is coming out, especially if your fingers aren't clean. So once you feel that the spout is over the cup, begin to move the cup and the pitcher at the same time until the cup is flat on the table.

Make sure to keep your finger inside the cup to monitor, to see if the fluid's going inside. And then you know to stop when the liquid hits your finger. Okay, another method that can be used, which is particularly helpful if the container's very heavy, is to allow the pitcher to slide down below the level of the tabletop. And start lining up the cup with the spout from there, again, using your finger to align the cup, edge of the cup with the spout, and then this way you don't have to move the cup and the pitcher at the same time.

You can just stabilize the cup on the tabletop. Another method for students that maybe don't like to get their fingers wet inside of the cup — can't tolerate the feeling of the liquid on their fingers — or if you're pouring a drink that's too hot, that you couldn't put your finger inside the cup or you would burn yourself: You could use what's called a liquid level indicator. And these are available from Independent Living Aids, among some other suppliers of specialized equipment for people with visual impairments.

What you do is you take the liquid level indicator and place the two prongs inside the cup and the battery part hanging on the outside of the cup. Then you can pour the drink without having to put your fingers inside. When the drink gets to the level of the cup where the prongs are, it makes a noise... (high-pitched tone) ...indicating when to stop.

CHAPTER 3: Serving & Utensil Use

SHANNON: And now we'll talk a little bit about serving.

Just as in pouring, there's a variety of containers, utensils and different types of foods that are presented to a child, and this poses some challenges when learning to serve themselves from a platter or bowl or dish, because, um, there is such a great variety and it's difficult to generalize the skill. It's important when a student's first learning to describe what it is that they're having in detail.

Maybe not just to say, "We're having chicken and potatoes," because that can sort of evoke a whole variety of different ideas of how... what you're going to be eating and how it will be presented, but to maybe say, "We're having chicken cutlets with mashed potatoes, "and we'll be using a spoon with the mashed potatoes, "and the chicken cutlets will be on a platter with a serving fork." And that way the student can begin to anticipate what it is that they're going to be expected to do and can kind of go into it with an image of themselves performing the skill.

The easiest skill, I think, is to serve from a bowl with a spoon, and sometimes it's easier if you're just going to have a student learn one thing or serve themselves one item, to do something that will be successful for them — to use the spoon and a bowl to serve themselves, say, peas or corn niblets, which is something that's fairly easy and successful for them to do.

So now we're going to serve some peas from a bowl with a spoon. And if you'll reach out for the platter to the left, using both hands, bring the bowl to touch your plate. Trace around the bowl with your finger to find the utensil. Stabilizing the bowl with your left hand, scoop toward your left hand. And stop and wait till you locate your plate with your opposite hand. Make sure you have a place for the peas, and then turn the spoon over gently. Now you can use your left hand to find the plate... the bowl, rather, and return the spoon.

Now you could pass that bowl to the right, to the next person at the table, and reach out now for the platter that has chicken cutlet, baked chicken cutlet with a serving fork. Again, you're going to trace around to find the fork. Then, using the fork, sort of check around the platter to see if you can locate the piece of chicken and guess where the middle might be.

Pierce it and again, pause to locate your plate, remembering to find a place that's not on top of the peas, maybe, on the other side of the plate from where you put the peas. And bring the chicken to your plate, and if it doesn't come off of the fork easily, you can use your own clean utensil that hasn't been used yet to encourage it off.

The next demonstration we have is using utensils. Utensil use could really pose a challenge for someone who's blind, because it's like using tools. Their fingers aren't the things that are getting the feedback immediately from the food. The tools are in their hand. They're an extension of their fingers, and all the action is taking place away from their hands. So it makes it sort of difficult for a student, especially that has difficulty conceptualizing space outside of their own body, to be able to develop skills with utensils.

We'll demonstrate the transition that a student... a child might go from holding a spoon to changing into a grasp for a fork, and then using their utensils maturely as adults. Typically, young children hold a spoon when they're first learning to feed themselves with a fist, like this. And that doesn't offer them a lot of control over the utensil, just enough to get whatever's in their bowl, usually a sticky sort of food, onto the spoon and into their mouth.

As their hands begin to develop more fine motor control — the control in their fingers — you'll see that they tend to hold the spoon more with their fingers than with their fist. And this is a... with the grasp in this way, they can sort of manipulate the spoon a little bit more, in a more controlled way, so that they can get different types of food off of their plate.

Now, this might be a good time to introduce a fork, because a fork requires a more distal grip, but with the palm turned up, to be able to pierce foods effectively and to be able to locate things on their plate.

There are several different adaptations to utensils that can help encourage this development, if it's a student that's having some delays in their development. When a student is first using a spoon, they could use a wider grip spoon and maybe a spoon that has a bit of an angle to it to help them keep the spoon going in the right direction. And maybe with a fork, as they're learning the fork, something with a larger grip to help them balance the fork on their hand more easily so that they can manipulate it with their fingers.

You could also make customized forks, customized grips on your fork so that a student has kind of a map for where to put their fingers. And then for students when they're first starting to use a fork, to be more successful in piercing, they can use something like a spork so that they can locate the food, pierce it and then also scoop to make sure they get something on their plate so it doesn't get frustrating. All of these utensils can be found at any rehabilitation equipment company or medical supply company.

Many times, one that we like to use is Sammons Preston. This customized grip can be created with a polymer clay and there'll be a link to that information below.

Another important skill for neat eating is to be able to use your knife as some sort of an assist to get the food onto the fork so that you don't end up chasing the food around the plate or knocking the food off the plate or using your fingers.

So to demonstrate this, we'll hold the knife against the edge of the plate, the side of the plate opposite to where you're scooping, and scoop into the knife to help keep the food onto the utensil. Now, you could also put the knife closer to your body. And scoop into it in that direction. It's really sort of more the preference of how the student tends to scoop with their utensil.

Now, another skill which is more complex is to use a knife as a pusher, where the knife is pushing the food onto the fork, and so both utensils are moving at the same time. And this is a little bit more advanced, because you're using two hands at once, rather than just kind of parking one hand with the knife when you're using it as a border.

Using it as a pusher, both utensils are acting at the same time. Now, to encourage more success in the beginning when a student is first learning to use this skill, a wider blade knife can be helpful. It sort of gives you more surface area, and that way the fork maybe won't get caught underneath the knife, or the knife won't end up wandering up off of the plate. And so, just as with the other knife, you could use it in any position on the plate where the student would find it more successful.

One adaptation to being able to use a knife as a border, if a student isn't quite ready for that skill yet because they don't have very good use of skills for holding utensils yet or tools, using tools, understanding the concepts of how the knife works away from the fingers, you might be able to use a piece of roll or a piece of bread as a pusher, and that way the student's hands are still close and can still kind of monitor what's happening with the food and not going onto the fork, but don't quite have their hands in their food.

Another idea would be to try a tip of a spatula, which is sort of similar. The tip of the spatula may not be as tempting to take a bite out of as the roll might be. (laughs) For students who really aren't able to use two hands, because they have some sort of inability to use one hand for a motor issue, they could use a plate guard, which is a plastic rim around the plate. This is another device that can be found at Sammons Preston or another rehabilitation equipment company.

The plate guard then acts as a border, so when you scoop across the plate, you can use the plate guard to hold the... keep the food onto the fork. Now, sometimes you might want to try to do this, use a plate guard when we're first introducing the idea of using a knife as a border for some students who can't tolerate holding the knife throughout the entire meal or aren't very successful with it right in the beginning, so we want to make sure that they do actually get something onto their fork, even if the knife isn't working for them.

CHAPTER 4: Cutting

SHANNON: Next we'll look at cutting foods.

Now, this is another somewhat difficult skill to learn because, again, there are so many different things to cut and there's different resistances of the foods, foods come in different shapes or even just it's hard to expect, um, to imagine what the food's going to be like when it comes to you. Even if you know it's broccoli spears, you know, some people cook broccoli spears so they're very squishy and some are very firm, so it's difficult to anticipate again.

So learning to cut a whole variety of foods is really important for kids. I think it's important that if you're teaching a student to cut, again, using a very systematic approach is very helpful to help develop a way to generalize the skills. And we'll demonstrate a few of those techniques. I think it's important that once you find a technique that works and is successful with your child or your student, to make sure that all the people that are teaching them or demonstrating for them are using the same technique, paying particular attention to whether the student is left- or right-handed-- particularly in cutting, because we switch utensils. So it's important that the student learns the same way all the time.

Next we're going to demonstrate using a knife and fork to cut. We're going to take the fork and locate the piece of meat. Now, they're holding the fork in the nondominant hand. If the person's right-handed, they'd be holding their fork in their left hand to locate the piece of meat. Find the edge of it and slide over a bite-size amount and pierce it. Then, taking your knife in your dominant hand, the hand that requires more skill — it has more skill and requires more skill to use the knife than it does just to stabilize with the fork.

That's why we teach it that way. You take the knife, find the cutting edge of the knife, either on the side of the plate or the fork... then slide down the back of the fork and saw back and forth until you get to the plate. And then, once you've gotten that piece cut, you're going to reach the knife under the fork to hold the meat stable while the fork then jumps over the knife. Roughly a bite-size amount. And then you can repeat it, sliding down the back of the fork and sawing back and forth.

So if you notice while you're eating that one piece is maybe a little bit too big, you can put the piece of meat back down, switch hands so you're holding the fork with your left hand again, pick up your knife, slide down the back of the fork. And that should be enough to cut the piece into a smaller, bite-size piece. Using Dycem underneath the plate can help. This blue mat underneath the plate can help to keep the plate from sliding around when a student's first learning to... learn how to modulate the force when sawing back and forth without sliding the plate all over the table.

Okay, so now we're going to demonstrate a method for cutting spaghetti. Spaghetti is generally very, very messy and very difficult to eat. But kids love it. So, this is a way that kids can be a little bit more successful with spaghetti. If you take your fork and knife in each hand and you're going to begin in the far part of your plate. I would say the front to the back, but that's sometimes confusing, so the part of the plate that's farthest away from you.

You're going to cross your knife and fork together and pinch the ends as you squeeze and pull them apart. You're going to repeat that all the way across the plate towards you. And when you get to the part that's closest to you, you're going to place your left hand and your right hand on the sides of the plate and turn the plate so that your right hand's at the top and your left hand's at the bottom of the plate. That's a quarter turn. And then you're going to repeat that again. So starting at the far end of the plate, pinch your utensils together as you drag them across the plate. Now you should have a roughly bite-size amount that will stay on the fork.

CHAPTER 5: Being Involved

SHANNON: As I mentioned before, we think it's really important that students feel that they're involved at meals — they're involved in a way that they're learning, that they are participating and that they feel a part of things, rather than just having things presented to them and taken away. They develop a sense of responsibility in that way for knowing where the food comes from, that somebody is responsible for bringing the food, cooking the food, preparing the food, and that... and cleaning up, and that they can take a part in those responsibilities eventually as they get older. A lot of times for students it's important to have a role at meals, to be the one that maybe brings the napkins to the table or brings out the drinks.

To have a job helps to develop that sense of responsibility in contributing to the family or to the classroom. A couple of other ideas, maybe, are to help with part of the meal preparation, even if it's just, you know, stirring something or maybe setting the timer to know when the dinner's going to be done. Maybe a student can offer, or your child can offer, to carry one of the serving dishes to the table, if you eat family-style, or also to clear the table at the end of the meal. Also it may be nice for a student to learn to clear a guest's plate who might come for dinner, and maybe even learn to rinse the dishes and put them in the dishwasher eventually.

This webcast is one part of a series on daily and independent living skills presented by Perkins. If you would like more information on this topic, you can follow the links below or contact us by e-mail if you have any questions or comments about this presentation.

Thank you.