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Wash and Learn: Teaching Hand-Washing to Children with Visual Impairments and Multiple Disabilities

visually impaired girl wearing a hijab and an apron washing her hands at a classroom sink

From the book Keys to Educational Success: Teaching Students with Visual Impairments and Multiple Disabilities, edited by Sharon Z. Sacks and Mary C. Zatta

Many children take a casual approach to cleanliness because it can interfere with having a good time or enjoying a delicious meal. All personal hygiene is similar to washing off invisible germs for students who are blind or visually impaired. Without seeing their image in the mirror or on their peers’ faces and hands, these students have to take the word of caregivers and teachers that it makes a difference whether their hair is brushed or their shirt is spotless.

Teaching basic hygiene skills to students with visual impairments and multiple disabilities often entails breaking those skills into small pieces. Within each step there are a myriad of lessons to be learned. To plan those lessons, you begin with a task analysis—a breakdown of the steps that need to be mastered. The following is a task analysis of the steps required for hand-washing.

1. Turn on water faucet.

2. Rinse hands under water.

3. Pick up soap or squirt soap from container.

4. Smooth soap over hands under running water.

5. Rub soapy hand without additional water in the following order:

  • Rub palms together.
  • Rub the back of the hand and wrist on the right hand.
  • Rub the thumb and each finger on the left hand.
  • Rub the thumb and each finger on the right hand.

6. Rinse front and back of each hand under running water.

7. Turn off water.

8. Find a towel and dry hands in this order:

  • Dry back of left hand.
  • Dry back of left hand.
  • Dry front of left hand.
  • Dry back of left hand.
  • Dry back of right hand.
  • Dry front of right hand.

9. Throw away towel if it’s paper. Hang up towel if it’s cloth.

10. Straighten towel if it’s cloth.

Once a task analysis has been developed, backward chaining can be used to teach the skill of hand-washing. Backward chaining begins by teaching the last step in the routine first, so that the student experiences success each time the routine is performed.

Step 1: After washing and drying the student’s hands with verbal and physical assistance, place the towel in the student’s right hand and have the student locate the garbage (it should be very close to the sink). Once the student has located the garbage receptacle, have her drop the towel into the container. Say, “Good, you threw away the towel.”

Step 2: Once the student has mastered throwing away the towel with verbal assistance only, fade first physical and then verbal prompts for drying her hands. When she dries her hands successfully, say, “Your hands are dry.”

Step 3: Once steps 1 and 2 are learned, stand behind the student and, after rinsing her hands with physical and verbal assistance, guide them hand-under-hand to the faucet and demonstrate how to turn the water off. Say, “Water off.” Fade physical assistance as the skill is mastered.

Step 4: Once steps 1 through 3 are mastered, it is time to add rinsing the fronts and backs of each hand under running water.

Backward chaining continues until the student completes all the hand-washing steps without physical assistance. It is important to diminish physical prompts during the process of teaching specific skills. A chart can be used to monitor the students’ progress. Examples of charts can be found in the AFB Press book Keys to Educational Success: Teaching Students with Visual Impairments and Multiple Disabilities.

This method can be adapted to teaching other personal hygiene skills such as hair washing and brushing, bathing, toileting, teeth brushing and nail care. But hand-washing is a good place to start. Once a hand-washing routine is established, the student can be taught to generalize those basic skills to a variety of situations.

For more teaching ideas for working with students with visual impairments and multiple disabilities read Keys to Educational Success: Teaching Students with Visual Impairments and Multiple Disabilities available from AFB Press at www.afb.org/store.

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