Sonia Maria C. de P. Arruda
Insertion into the community is an essential condition for the social inclusion of visually impaired individuals. The process of including a child in a social environment is stimulated by intervention at home and at school.
Activities of Daily Living (ADL) based on the Piagetian theory were used for a period of 2 years at school and in the family with blind or low vision children, aged between 3 years to 9 years, to improve their development. The children were able to learn and promote their development because of the guidance given to regular schoolteachers and parents on the utilization of ADL.
The family was made aware of the fact that active participation was the first objective for promoting the child’s insertion and development. Moreover, teachers in regular schools were made aware of the fact that visually impaired children could independently and autonomously use their very own methods to progressively develop mature cognitive, motor and social skills in daily living activities. Thus, demonstrating that the practice of activities of daily living could successfully improve the inclusion of visually impaired children in their environment, contribute towards a better educational system and improve quality of life.
Author: Sonia Maria C. de P. Arruda
An essential condition for the social inclusion of visually impaired individuals is their insertion into society. In Brazil, numberless projects have been developed to promote the inclusion of children, adolescents and adults into the social system.
Governmental and non-governmental preoccupation exists regarding education for all and promoting inclusive education, especially after the Declaration of Salamanca (1994). This declaration has been a basic reference for recent debates and projects in education because it is based on a common system for all students and proposes that schools should be successful regarding the education offered and independent of physical, intellectual, social, emotional, linguistic or other conditions.
The WHO (1997)1 estimates that 10% of the world population has some kind of deficiency and the incidence of visual impairment in developing countries is between 1% and 1.5%. “Nine out of ten of those who are blind live in the developing world. In general, more than two-thirds of today’s blindness could be avoided (prevented or treated) by applying existing knowledge and technology”.
Prevention and control of ocular problems, however, partly depends on the actions of the individual, himself, which should be based on correct knowledge, attitudes and conditions that propitiate preventive behavior. It is important that all those who are related to individuals who are visually impaired develop attitudes that favor health and this can be achieved through education and attention, which should be initiated in childhood 2.
Specialists agree about the importance of vision in the learning process and the need for early diagnoses and treatment of ocular disorders so that these problems can be minimized and resolved 3.
According to KARA JOSÉ et al4,5 ophthalmologic problems at school going age should be a priority of the school health program so that the largest number of children who need specialized care and adequate treatment are detected.
From birth, a child learns to eat, touch objects, hold and use them. Later, at school, he learns to perform the activities of daily living (ADL), gradually achieving independence and autonomy. In like manner, a visually impaired child has to learn and perform his ADL. It is fundamentally important for the child to know the different objects around him, especially because of contact with things and people and mainly because of the interaction that he establishes.
PIAGET6,7 (1995) states that it is through interaction with objects that the individual builds knowledge and assimilates their characteristics and accommodates them in new schemes.
The piagetian theory explains the existence of specific mental structures involved in the act of learning, similar to other structures that have other functions in the organism. They do not simply appear, but result from the interaction of the organism and the object, depending on the needs of the medium, the actions and coordination. To learn about an object, the individual needs to handle it, transform it and learn the mechanisms of this transformation, which results in building knowledge.
If knowing an object implies an interaction with it, action is necessary for cognitive development that cannot be considered without the child’s activity. This activity is not only physical but also an activity or internal experience consisting of a reflexive elaboration of the manner in which perceptions and actions are coordinated 8.
An emphasis on the acquisition of knowledge is linked to ADL, because through these activities the child’s development can be indirectly stimulated, or in other words, the use of necessary daily routine activities awakens the child’s interest in the acquisition of new knowledge.
This study proposes the importance of prevention and early detection of problems in the development and social inclusion of a visually impaired child - blindness and low vision, and it also amplifies the concept of ADL because according to Piaget 7 an analysis was performed of the physics, mathematical logistics and social knowledge involved in the development of cognitive, social and affective aspects9.
An exploratory research using a qualitative approach was conducted based on the piagetian theory. It was the responsibility of the health team to identify the repertory of knowledge and vocabulary used by the community being studied 10.
This study was conducted at CEPRE, a university center for research study, at UNICAMP – State University of Campinas, Brazil. The study sample consisted of visually impaired children –blindness and low vision, their families and the teachers at a regular school. Activities of Daily Living were utilized to find out how they could be used as instruments of knowledge as well as help the child develop in the family and school. The children were between 3 to 9 years old and the study extended over a period of 2 years.
The groups were a practical manner of putting similar cases together:
- group of blind children and their parents
- groups of children with low vision (visual far acuity 20/80 to 20/200) and their parents.
- group of teachers from a regular school
They were provided with:
- group and individual guidance for children
- group and individual guidance for the parents
- group and individual guidance for public schoolteachers
3.1 – INTERVENTION PROCEDURE
The procedures adopted were related to an improved understanding of the aspects that could be used in ADL.
- The children were assessed according to their ADL performance (knowledge, interest and necessity).
- Attention program was organized with objectives, proposals and stages for each child, even when they worked in groups.
- The use of residual senses, language and concrete activities in learning ADL were stimulated.
- In the case of low vision children, the utilization of residual vision, optical and non-optical aids were also stimulated.
- The parents participated in the attention
- Home visits were performed
- The parents’ needs were met even when they worked in groups
- School visits were carried out
- The teachers received guidance during 4 meetings held at CEPRE as part of the intervention of the Children’s program.
3.2 PROGRAM OF ACTIVITIES
The ADL program and the themes discussed were related to:
(wash hands, put toothpaste on toothbrush, brush teeth, comb hair, Take a shower, use shampoo, cut / file nails, to find /distinguish cleaning products, hygiene after using the toilet /restroom etc.)
(distinguish, localize, identify and organize clothes and accessories ; distinguish back /front , right side /wrong side ;dress/undress , tie a knot and bow, to put on / remove socks and shoes ; hang up , store etc.)
(orientation and the control of the food in the plate , using cutlery , serving others / serving himself liquids and solids; locate, distinguish and use different ingredients or utensils ; prepare snacks and juices , eat , drink etc.)
(distinguish name, identify, locate and use furniture /objects in the home ; house cleaning :dusting , sweeping, washing , ironing, washing dishes etc.)
(greetings , right posture , body gestures , politeness , etc.).
3.3- ATTENDING CHILDREN IN GROUPS
The objective of attending children in groups was to improve the daily routine activities of a child through experiences and cognitive activities that would help in the child’s integral development10.
3.4- INDIVIDUAL ATTENTION
Individual attention was given only when intervention by the group of children or parents was not enough to efficiently accomplish DBS. The attention given was specific and accompanied by the mothers or those responsible. The program focused on affective, social, motor perceptive and cognitive objectives in order to bring about the integral development of the child.
3.5 - Domiciliary Visits
Visits and work at home were some of the strategies used in intervention. The physical aspects of the home and the family relationship are noted. If necessary, organizational adaptations were made so that the child could participate actively.
3.4- School Visits
Teachers and other school employees who worked with students sent by CEPRE were given orientation and accompaniment in relation to specific DBS and the individual necessities of each visually impaired child. This procedure helped and hastened the integration of the student in the school and assured his independence and autonomy.
The other students in the school learned to respect and get to know their handicapped fellow classmates. This guidance took place at CEPRE and or at the regular school, where the child was enrolled. The school can contribute towards the inclusion of handicap students by having a favorable approach towards the admission of these children in a regular school.
Orientations provided for the parents of visually impaired children and their teachers in regular schools on the utilization of ADL contributed towards a detailed study of ADL and the fact that knowledge can be developed when these activities are carried out8,9. The development of those children who learnt to perform the ADL and acquired knowledge was also favored.
Concepts of shape, texture, color, consistence, temperature, weight, odor; conservation of discreet or continuing quantities, classification, serialization, conservation of weight, space and time were analyzed in the ADL.
The family was made aware of the fact that active participation was the first objective for promoting the child’s insertion and development. Moreover, teachers in regular schools were made aware of the fact that visually impaired children could independently and autonomously use their very own methods to progressively develop mature cognitive, motor and social skills in daily living activities10. Thus, demonstrating that the practice of activities of daily living could successfully improve the inclusion of visually impaired children in their environment, contribute towards a better educational system and improve quality of life.
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