MOVE Curriculum: targetting kids, infant development programs, adults and students with orthopedic handicaps.

MOVE International

Linda Bidabe, MOVE administrator and creator, has conducted training workshops in the United States, Europe, Australia, New Zealand, Japan and South America. With new hope, personal and professional caregivers flooded these sessions. But the burdens and joys of liberating individuals with severe disabilities are only now becoming understood.

Both learners and caregivers require further education, guidance, reinforcement, new supportive equipment, proper research, new techniques and new knowledge if exciting progress is to continue to unfold.

MOVE International seeks to improve the overall quality of life for people with severe disabilities and for the people who care for them, regardless of age or cause of disability. It also seeks to promote fuller participation in home, school, work and community life and to encourage the dignity and hope such participation brings to each individual.

Program Overview

MOVE is a top-down, activity-based curriculum designed to teach students basic, functional motor skills needed for adult life within the home and community environments. It combines natural body mechanics with an instructional process designed to help the students acquire increasing amounts of motoric independence necessary for sitting, standing and walking. The MOVE curriculum provides a foundation for parental leadership in the selection of student activities. The format helps coordinate services provided by therapists, educators and non-professionals.

Target Population

The program was originally designed to meet the needs of children over age 7 who had not developed the physical skills necessary to sit independently, bear weight on their feet, or take reciprocal steps. Because of the worldwide success of the program, the targeted population has been expanded to include infant development programs, adults and students with orthopedic handicaps only.

Early Beginnings

The need for this program became apparent when non-ambulatory students began graduating from the public education system at age 22 with fewer skills than when they entered at age 3. The program was conceived after several surveys were conducted concerning the needs of 100 students with the most severe physical and cognitive delays. These students were between the ages of 3 and 22, but the majority were functioning below the six-month level of development both physically and cognitively, according to the Brigance Diagnostic Inventory of Early Development and the developmental assessment according to Gessell. The results of these surveys showed:

Communication Skills

Other than smiling or crying, the majority of the students had no expressive language. Speech therapy which included augmentative and alternative language training produced little or no change in communication skills. The majority of the students appeared to have far better receptive language than expressive language, i.e., many responded by looking at the speaker to their names and words like Mama, bus, eat and drink. A physical assessment was made of the students to determine the most logical form of alternative communication. The students were then introduced to a program developed at the Blair Learning Center to teach students symbolic representation.

As an example of the program, the students were taught to touch or look at a paper cup filled with their favorite liquid to indicate the desire for a drink. When the student reached a proficiency level, an empty paper cup was cut down until only the circular bottom remained. It contained a picture of a cup, and the student therefore was using symbolism to indicated the desire for a drink. The same method was used for the category of food which began with a real spoon with a favorite food and ended with a small picture of a spoon. Using the same technique, varieties of food and drink were offered. The shocking result of the program was that the students who had any sort of mobility skills (crawling, rolling, squirming) were able to succeed in the program and make meaningful choices. Those students who lacked any sort of mobility were unable to make meaningful choices. At that time, we did not know whether they were cognitively unable to differentiate or whether they did not understand that they had options.

Eating Skills

The majority of students with motor delays required one-on-one assistance at meal time. Most of the students had severe feeding problems complicated by chronic upper respiratory distress. At minimum, a class of 10 students with motor delays required five hours of adult assistance to consume lunch (30 minutes per student). The most obvious problems were lack of head control, tongue thrusting and an uncoordinated swallow pattern.

Toileting Skills

Students under the age of 7 were routinely placed on toilets. Toilet training efforts were reduced or completely dismissed as students grew older, became heavier, or developed deformities which made sitting difficult. When possible, students had diapers changed on changing tables. As they grew too large to be lifted safely, they were changed on mats on the floor or in bean bags.

Large students with skeletal deformities took an average of 20 minutes of adult assistance for a single diaper change (2 adults X 10 minutes). A class of 10 large students with motor delays required three hours and 20 minutes of adult attendance for custodial care a minimum of twice a day.

Motor Skills

Therapy services were provided by the Kern County California Children's Services (KCCCS) for those students who had medically eligible diagnoses and were deemed capable of making measurable progress in developmental activities. The vast majority of the therapy services were delivered in the "consultant" mode. That is, the therapist would discuss the child's needs with the classroom teacher and instruct the teacher in positioning and activities that would benefit the person. The classroom teacher would then try to fit those activities into the child's classroom day.

A number of articles published by E.E. Bleck, R.K. Beals and others reported that children over the age of 7 who had not gained independent motor skills by 7 were unlikely to ever do so using traditional developmental programs based on the sequential skill acquisition of infants. The students at the Blair Learning Center supported these findings.

Home Life

Students who could be lifted and carried easily were taken out into the community with the rest of the family. As the students grew larger and more difficult to lift and transport, they stayed at home more often. The majority of non-ambulatory teenage students went into the community only to attend school (via wheelchair bus) and for medical appointments. When the family went out, one family member would stay at home with the non-ambulatory person or occasionally a sitter was hired. Sometimes, the non-ambulatory person was left unattended for short periods of time.

Bathing was considered the most difficult task to be performed in the home. Many students were bathed once a week in a bathtub or shower and had sponge baths in bed the rest of the time. Usually the student ate at different times than the rest of the family and often ate in a reclining or semi-reclining position either in the living room or bedroom. Diapers were often changed in the same environments because moving the student was so difficult. The mother often slept with the non-ambulatory student because of the periodic need for repositioning or other attention during the night. Home environments as well as community environments decreased in direct proportion to the severity of physical handicaps and the size of the students.

School Life

The classes for students with severe handicaps averaged 10 students per classroom with a teacher and an instructional aide. Between the teacher and aide, 10 hours of instruction were available, which if divided equally, gave each student 60 minutes. Students who were non ambulatory and functioning below one year on the developmental scale required one-on-one assistance for participation in any activity. Lunch required a minimum of 30 minutes per student, and changing diapers or toileting required an average of 10 minutes per change. Custodial care (two diaper changes and lunch) required 50 of the 60 minutes available per day. Students who were too large to be lifted by one person required even more of the available instructional time. Additionally, many of the students with severe physical disabilities required specialized procedures such as putting on and removing braces, postural drainage, periodic suctioning, etc. Instructional time decreased in direct proportion to the severity of physical handicaps and the size of the students.

Purposes Of The Program

MOVE is designed to:

• Use education as a means of systematically acquiring motor skills.
• Use therapy services for cyclic corroboration, i.e., therapists help establish an individual's functional program, help train staff to use the program, and periodically (on a cycle) work with the individual and staff to update the program.
• Provide a program whereby participants naturally practice their motor skills while engaged in other educational or leisure activities.
• Reduce the time and energy requirements for custodial care.
• Provide a way to measure small increments of functional motor skills and therefore provide a way to show improvement.
• Provide a sequence of motor skills which:
  • are age appropriate and based on a top-down model of needs rather than the traditional developmental programs based on sequential skills acquisition of infants.
  • are valuable and usable to the participant right now as well as in adulthood.
  • increase the availability of environments in the community and in the home.
  • range from the level of zero self-management to the level of independent self-management.
• Provide the individual with the basic motor skills needed for development of other skills such as expressive language, self care and work opportunities.

MOVE is based on teaming the expertise of therapy and education to address the functional needs of students when they become adults. This teaming has resulted in the development of equipment being manufactured by the Rifton Manufacturing Company of Rifton, New York, which has been designed specifically to meet the following needs: The equipment places students in positions for performing functional activities such as moving from one place to another, self-feeding, self-controlled toileting, table work and leisure activities

• The equipment allows the staff to physically manage the student while teaching appropriate movement patterns
• The equipment allows the students to practice motor skills independently
• The equipment is designed to help improve the bone and joint health of the students and to increase the muscle strength of the extensor musculature of the body

Eligibility For The Program

Exclusion from the program is limited to those individuals whose medical needs contraindicate the need to sit, stand and walk. Access to medical consultation and/or physical therapy is needed for students who have the following conditions:

• Head too large to be supported by the neck
• Circulatory disease which prevents the participant from being placed in a vertical position
• Respiratory distress
• Brittle bones
• Muscle contractures
• Curvature or rotation of the spine
• Hip dislocation
• Foot or ankle abnormalities
• Pain or discomfort in any part of the body

People with paralysis or degenerative neuromuscular diseases can continue to participate to improve bone and joint health for as long as it is medically feasible.

The Top-Down Model

The foundation for MOVE was laid by interviewing parents about their children's needs and analyzing the basic minimal activities necessary to adult functioning in the home and community. Some of these activities included:

IN THE HOME

• eating with family or peers
• bathing or showering
• getting in and out of bed
• dressing and grooming
• toileting
• communicating
• participating in leisure activities

  IN THE COMMUNITY

• shopping
• going to appointments (medical, dental, hair dresser or barber, etc.)
• eating in restaurants
• attending social activities indoors and out-of-doors (church, picnics, movies, etc.)
• using public restrooms
• riding on public transportation or in regular cars

Task Analysis

Each of these activities was then task-analyzed to determine the physical skills required in order to accomplish these skills. The skills fell into 16 categories: