Orientation and mobility guidebook for parents and teachers of visually handicapped students

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ORIENTATION AND
. MOBILITY GUIDEBOOK
for Parents and Teachers of
Visually Handicapped
Students

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ORIENTATION AND
MOBILITY GUIDEBOOK
for Parents and Teachers of
Visually Handicapped
Students
Division of Special Education and Pupil Personnel Services Office of Instructional Services Georgia Department of .Education Atlanta, Georgia 30334 1970 Jack P. Nix State Superintendent of Schools

Preface
This guide to techn iques in independence offers some help to those who work with visually handicapped students of junior high school age or older . It was developed as part of the outcome of a workshop for parents and teachers of the visually handicapped supported by Public Law 85-926 as amended .
Acknowledgement is made of the work of D. Gary Coker, Orientation and Mobility Instructor at George Peabody College, whose students are expected to develop their own notebooks. Much of what is included here was developed for his class and in response to his teaching . He is not respon sible for content, however.
It is said that orientation and mobility begin with a baby on a blanket. Parents are the first to imbue a child with trust and courage to move about. The visually handicapped in fant needs to be played with, rolled about, stimulated through his remaining senses and encouraged as much as possible to explore the world around him.
The preschool child needs to have many varied first hand experiences. He should be encouraged to care for himself, to move about his house and yard independently, to go to play with other children, to visit all parts of the commu nity.
His attention should be directed to the sou nds, smell and feelings of places he passes on walks, and care should be given to helping him identify those places through sensory clues.
When he enters school, much can be done toward making him an independent traveler in and around the school ca mpus. An orientation to the school layout, the location of the office, lunchroom, rest rooms, water fountains, library and gymnasium will enlarge his hori zons, improve his sense of achievement and make him self sufficient.

The auditory sense uses binaural hearing , or sou nd localization, to detect the exact line or source of a sound . Playing games ca n encourage children to use sound clues. Obstacle detection is possible through the use of facial (cutaneous) vision. Th is was at one time thought to be a si xth sense unique to the blind but has now been found to be the result of auditory feedback or location echo.
Certain factors affect auditory perception. Th ese include how well the person hears, his memory abi lity , previous exper ience and personality factors. Is he aggressive or withdrawn? Is he attentive or preoccupied? Does he associate experiences, transferring past experience to present problem solving?
The hands and feet are used in tactual orientation, and extensions such as a cane or dog can also be described as tactual. The ca ne or canine extend the range of tactual orientation.
In the use of the kinesthetic sense posture, reflexes and muscles are brought into play. Oftentim es "muscle memory" will occur, in wh ich the body takes over movements of often repeated acts so that responses seem almost automatic. Kinesthetic distances may seem longer than sight distances.
The inner ear semi-circular canals play a non-auditory function in the use of labyrinthine sense. Then the movement of the head st im ulates balance.
The olfactory sense, or smell, serves as a clue in orientation to many surroundings and may also serve as a safety device.
The gustatory sense, or taste, plays a role in orientation for clues to environment. Smell and taste are closely related .
Any remaining visual sense helps in light and obstacle perception. However, remaining vision may be a deterrent to sense training, so a blindfold may be used on those persons who have remaining vision to develop keen awareness and create confidence in the remaining senses.
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MOBILITY
Mobility is t he ability to navigate effectively from a fi xed point to a desi red poi nt in the environment . The aim of mobility is to move safely and gracefu lly w it h an awareness of the environme[lt, from one place to anot her.
Formal training in mobility and orientation began after World War II with a Val ley Forge rehabilitation program for blind veterans. Here the long cane technique was developed by Richard Hoover, fo rm er math teacher and wrestling coach at Maryland School for the Blind. He was an arm y sergeant who was brought to Valley Forge because of his previous experience with the blind, and he experimented with and developed the technique for use of a long, lightweight, functional cane. Richard Hoover later studied medicine and became an ophthalmologist well known in the health, education and welfare of visually handicapped persons.
At Hines Memorial Hospital in Hines, Il linois (a Veteran's Administration Hospi tal), only veterans received training . Physica l therapists, called "orientators," were used in this program.
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PROFESSIONAL TRAINING PROGRAMS
The Vocational Rehabilitation Admini stration allocated f unds t o establish a master's degree program for teacher t raining in ori entat io n and mobility at Boston Col lege in 1960 and at West ern M ic higan University in 1962. Requirements for these programs in cluded a bachelor's degree; a background in edu ca ti on, psychology or social work; vision correctable to 20/20; normal hearing and good physica l condition; flexibility and ability to compromi se. It was also f el t th at the person should not be impatient, possessive, impul sive, intol erant, embarrassed, dishonest or morbid. Boston College coined the wo rd "peripatologist" to identify their trained specialists.
Training programs at the bachelor's degree level were esta bli shed when the U.S. Offi ce of Edu cation alloca ted f und s t o Fl orid a State University in 1966 and to California State College and San Fran cisco Stat e Col lege in 1967. An appli cant for adm ission to these programs had t o have senior-year status, prerequi sites in spec ial edu cati on, vi sion co rrecta ble to 20/20, normal hearing, good physical conditi o n, f lex ibi lity and t he ability to compromise . The same perso~al qu alit ies were sou ght in candidates for the programs.
Trainees in these programs study physi cal ori entati on and mobility, th e dynamics of human behavior as related to blindness, fun ct ion s of th e body as related to blindness, sensori um as related to blindness, cultural and psychological implications and practical applications of training in real life situations.
The purposes of the mobility and orientation trai ning are to enable the blind person to act with confidence upon the techniques he has mastered, to expose the blind person to situations which will make him aware of his environment and enable him to move about in it and to give him physical independence and psychological freedom.
USING A SIGHTED GUIDE
There are three accepted modes of travel for the blind person - -using a sighted gu ide, a long cane or a guide dog.
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The main advantage of the sighted guide is that it is a fast and efficient means of travel. In the use of a sighted guide (the word "guide" and not "lead" should be used), several considerations are important. The guide must feel comfortable and the companion must trust the guide.
If the guide must leave his companion, he should always give him a landmark.
The sighted guide technique includes- -
Proper gr ip- -The companion lightly but securely grasps the guide's arm above the elbow by placing the forefingers on the medial or inner side, with the thumb on the lateral or outer side.
Proper body positionThe compan ion travels a half step back of the guide. When the guide stops, the companion comes up beside him. When starting out again, the guide may say when offering his arm, "Do you .want an elbow?"
Help in congested areas or narrow passages-- The guide extends an arm laterally back, to guide his companion into a position directly
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behind him . The companion completely extends his arm so as not to come into contact with the gu ide's feet . When the guide stops, the
companio n takes up the lag and stops beside the guide, assuming the usual position.
Help in negotiating steps--The approach to steps is always perpendicular. The guide touches his toes to the steps and pauses. The companion comes up next to the guide and touches his toes to the step. In climbing the steps, the companion stays a full step behind to avoid a false step at the top. In descending the steps, the guide pauses and extends the ball of his foot over th e edge of the step and th e companion comes abreast. Verbal clues may be given in unusual situations.
Help with swinging doors-The approach to doors uses the same technique employed in traveling
through narrow passageways. Verbal clues are given in the beginning telling the direction the door will swing, i.e., "Out and to the right ." Later the companion will judge direct ion by body movements of the guide and auditory clues. The companion brings up his forearm for protection and grasps the door with that hand. The companion needs his hand free on the side of the opening door, so he may have to change
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his hand grip to the guide's other arm. The companion closes the door and they resume the usual body positioning.
Help in auditorium or theater seating--When entering the row of seats, the guide and companion turn sideways. As they move between the rows, the companion trails his fingers along the back of the seats. The guide stops the companion directly in front of his seat. Both legs must touch the front of the seat before the com pan ion sits down. The companion clears his chair of obstructions with a hand sweep.
At times the "Hines Break " or the "Limp Arm Method" must be employed in dealing with well-intentioned persons who wish to help but do not know the correct way to guide.
In the Hines Break the blind person brings the arm that is grasped across the front of his body and with the other hand takes the arm of the person, using the proper grasp, and says "May I take your arm?"
The Limp Arm Method is used for handling people who try to help by dragging a blind person along. The blind person goes completely limp so that the other person has to drag him and says, "May I take your arm?"
INDEPENDENT TRAVEL TECHNIQUES
There are several independent travel techniques. In trailing, the blind person is able to determine a place in an environment, locate objects, and maintain a travel pattern . This is done by using the back, distal portion of the third, fourth and fifth fingers to follow lightly over a straight surface. The upper arm is close to the body in a relaxed position, and the lower arm follows a natural swing, slightly in front of the body at a 45 degree angle. The fingers are pointed down with the index finger acting as a bumper.
In times of danger and unfamiliar environment the Hand and Forearm Across the Body (HFAB) position is used as protection for the area above the waist. In this position the forearm is placed at an obtuse angle across the upper body . The ulnar side of the arm faces out, with the fingers parallel to one shoulder and the elbow parallel to the opposite shoulder.
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Protection in the area of t he wa ist is achieved by use of t he extend ed arm position. The ulnar side of the arm is placed about six inches in front of the body at the wai st, wi th th e little fi nger on the outer si de. Th is device may be used simultaneously w ith the Hand and Forea rm Across the Body.
DAILY LIVING SKILLS
T he learning of daily living skills enables the bli nd perso n to meet everyday situations with assurance. When a blind person meets a sighted person and desires to shake hands, they should stand face to face. (Auditory clues will help the bIind person.) He then offers his hand to the sighted person by bringing the hand forward to the center of his body at waist height. He may give a mental count of one, two. If no one takes the hand, he should put it back down by his side.
A bl ind perso n ca n also make a th orou gh sea rch fo r lost object s. If th e object ro lls, he mu st wait until it stops before trying t o determine its locat ion. He th en goes down in a pivoting position on his f eet and st art s sea rching in fro nt. He begins moving his hands in small circles and gradu ally enlarges the circles. If he must ex plore a table tope,he uses one hand as a guide and goes back and forth with the other hand .
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In reading a bra ille watch the blind person opens the watch crystal, places his fingers directly in the center and then checks the hands. (This will prevent the accidental moving of the watch hands.)
To enter a car, the blind person must first examine the car to determine which is the front end. He then trails the side of the car at a point just below the glass to the divider between the doors, or at the edge of the door in a two-door car. He opens the door completely, checks the seat height and type (bench or bucket) and places his hand on the top of the car, goes under the hand on the car to protect his head, and sits down. His cane is placed on the floor between t he seat and door, or on a seat away from the driver's side. If the blind person has a dog guide, the dog enters first and positions himself on the floor of the car.
Here are three methods of d ialing the telephone.
In the first method, the index finger locates the metal division between zero and one and the blind person counts counter clockw ise around to each number.
The seco nd method is t o be used if t he next number is easier t o reach from t he dia l number's posi t ion . The index
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finger is located in the same position as in the first method, but the index finger remains with the dial hole . Numbers 1 through 5 are
counted counter-clock -wise and numbers 0 to 9 are counted clockwise.
A rubber band may be used between numbers 5 and 6 as a landmark for faster location of median numbers. In the third method, the fingers are placed in odd number slots. Dialing is done by pulling the fingers around and letting the dialer go back to its original position. Even numbers are reached by moving the first finger. This method takes practice.
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Orientation and Mobility Terms
Clue Any sound, odor, temperature or tactile stimulus affecting the senses and readily converted in determining one's position or a line of direction. Direction Points in one's environment according to a generalized rule. Direction takers Any fixed, straight-lined object whose surface lines when projected into space will give a course of travel in a given direction. Direction taking The act of getting a line of direction from an object or sound to better facilitate effect ive travel to a destination . Domina nt Clue Of the maze of clues that are present, the one that most adequately fulfills all of the informational needs at that moment. Landmark Any familiar object, sound, odor, temperature or tactile clue that is easily recognized and that has a known and exact location in the environment. Mobility The ability to navigate effectively from one's present fi xed position to one's desired position in another part of the environment. Orientation The process of utilizing the remaining senses in establishing one's positton and relation ship to all other sig nifi ca nt objects in one's environment .
Run The term used to denote a course or route mapped out and traveled to a destination. Shore L ine A change of surface, usually the border or edge of a sidewalk or grassline. Sound Localizatio n Determination of the exact bearing or line of direction of the source of a sound . Squaring Off The act of aligning and positioning one's body in relation to an object, for the purpose of getting a line of direction and establishing a definite position in the environment .
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Trailing The utilization of the back, dista l portion of the 3rd, 4th and 5th fingers to follow lightly over a straight surface.
(a) determination of place in environment . (b) location of objectives (c) maintenance of a travel pattern . Travel Pattern A desired line of travel in a direction or to a destination.
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Concepts All Blind Children Should Know and Understand
Right and left Forward and backward Up and down Straight and curved turns
(right turn, left turn, about face, 45 degree turn, and 90 deg ree turn, 180 degree turn , and 360 degree turn --turn shou ld be produced with a relationship between quarter, half, th ree-quarter and fu ll turn ) Compass directions (north, south , east and west) Verti cal and horizontal Parallel and perpendi cu lar Fl at and sla nted Narrow nd w ide Bumpy and smooth Shapes (circle, rectangle, square, triangle)
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Suggested Ways for Handling Money
There are four coins with mil led edges in varying sizes and weights which may be used for identification purposes. They are the dime, quarter, ha!f-dollar and silver dollar. Of the four, the dime is t he lightest, the quarter is a little heavier, the half-dollar is heavier than the quarter, and the silver dollar is the heaviest of aII.
The dime is 22/32 of an inch, the quarter is 15/16 of an inch, and a halfdollar is 1 and 3/16 of an inch. The silver dollar is the largest of all coins. Milled edge coins which have become smooth with usage may be identified by size alone.
Of the non-milled or smooth-edged coins, the penny is the smallest and lightest, and the nickel is the largest and heaviest.
When receiving paper money the blind person must rely on the honest y of the giver. It is important to have a sighted friend to interpret the value of the bill.
In folding money for identification, the one dollar bil l need not be folded because of its frequent use. The five dollar bill is folded crosswise, like a book. The ten dollar bill is folded lengthwise with the crease running the length of the bill, making it the narrowest of the folded paper money. The twenty dollar bill is folded crosswise twice and lengthwise once and is tucked away in a corner of the billfold. Bills of higher denominations should not be carried; however, a separate compartment in the billfold is recommended, if large bills must be carried.
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Eating Techniques for the Blind As Presented by Therapists in Rehabilitation
Of Newly Blind Adults
Newly blind adults should become familiar w ith eating techniques befo re actually eating a meal . The patient's eating habits and problems are discussed wit h a the rap ist and the eating prog ram and how it is co rrelated with the entire training program is explai ned to the patient.
T he patient rece ives pr ivate tuto r ing wit h utensi Is and a food free tray at a pr ivate tabl e in the mess hal l. A t this ti me posture, t he importance of havi ng a t horoug h kr')Owledge of the tray to prevent accidents and in struct ions in seasoning of food are stressed.
When actual eati ng practice is desi red, a prepared tray is brought to a private table w here the patient ca n pract ice the above techn iq ues and gain experience under actual eating co nditions. Th e performance is repeated until it is satisfactory.
Then the patient jo ins others in eati ng at the mess hall. At thi s tim e the instru ctor silently observes and checks the patient on points needing further inst ruction. Th e pati ent 's weak po ints are discussed w ith him in pr ivate.
EATING TECHNIQUE
A tray with food and silverware on it is set before the patient. The patient may or may not receive an accurate description of the contents from the attendant. In either event a personal explorat ion is necessary.
Posture - The patient assumes a normal and erect sitting position . Both
thumbs are placed on the edge of the table, at least 3 or 4 inches apart, while the other fingers, curled under, rest on the t able surface. He then extends the cu rl ed fingers, locates the tray and draws it to the thumbs.
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Exploration of tray outline- The instructor will direct the patient's hand movements from the opposite side of the table by placing his finger tips to the back of the patient's hands. The same technique may be used throughout the entire tray exploration when necessary.
With hands moving in opposite directions, the patient slides fingers along the bottom edge of the tray to lower outside corners, then up the sides to the upper corners. At this point the instructor may have the patient attempt to slide his fingers across the top of the tray to demonstrate the inconvenience caused, such as knocking over containers and allowing sleeves and cuffs to become soiled. He continues the demonstration by allowing the patient to return his arms and hands to the bottom edge of the tray by moving through the center of the tray.
Exploration of tray to determine the relation of dishes and utensils to main plate- Exploration of the tray should be done in two parts, using the right hand for the right half of the tray and the left hand for the left half of the tray. This allows more freedom of movement and prevents mishaps.
The patient slides his right hartd along the right edge of the main plate with his fingers on the surface of the tray. He gently allows the main dish to slide to the left, keeping his thumb in constant contact with the plate edge. With his left hand resting on the bottom edge of the tray, his fingers curled under and on the tray surface, he places his index finger and thumb on the lower ql18rter of the plate edge to control the movement of the plate caused by the forward motion of the right hand.
The left hand should remain in this position until exploration by the right hand is completed. The patient extends the fingers of the searching hand, allowing them to lightly touch containers, dishes, utensils, etc., until all have been explored in the path of the hand from bottom to top of tray. He slowly withdraws his hand over the same outer edge of the tray to determine more thoroughly the type and location of containers and also to search for possible hidden utensils. On reaching the top of the tray, he slowly returns his hand
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over the same area (double checking and preventing careless habits) to the starting position. T he instructor should emphasize and demonstrate the importance of withdrawing hands through an area previously explored .
The same procedures are repeated for the left half of the tray, with the left and right hand performing opposite duties.
Exploration of contents in all dishes and containers - The patient explores the main dish with a fork to determine the location and type of food. If necessary , he shifts the plate by employing both hands to plate edge to do so . It is permissib le to shift t he plate to a mo re desi rable position, to suit the individual's need for cutti ng and eating of t he food . It may be necessary and is permissible to taste t he food t hat may have clung to the fork . In tasting the food , two t hings are dete rmined : ~f more seasoning is desired and food identification.
The patient secures the fork with the left ha nd and Withdraws it to t he bottom edge of the tray. Wit h fork in an upr igh t positio n, he th en sl ides bot h hands along the edge towa rd the center to exchange t he for k from t he left to t he r ight hand. He holds t he fo r k in a natura l position, th at of eating, and turns t he fo rk toward his body, extending t he little finger in order to locate the plate edge. Then he returns back to a natu ral position. The plate must be approached f rom a heig ht of at least 3 or 4
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inches. The patie nt checks food by lightl y st ick ing h is fork into it , as he r. ircles t he plate f ro m item to item, cou nter-clockwise. He may occas ionally t aste if so des ired .
Side d ishes are located by sliding th e left ha nd along the outer edge of the tray to the upper lef t- hand corner. The pat ient mentally anchors the sid e dish by employing his th umb and forefinger t o its edge. Th e path of the r ight hand and fo r k w il l be f rom t he mai n dish, w hich he has just fi ni shed examini ng, to t he spot now pictu red by t he left hand. A t t hi s point he proceeds to check t he co ntents with the fork and taste if desi red .
If soup is be ing served on t he t ray, t he pat ient sl ides his left hand down t he outer edge to t he lower left- hand corner. He locates the soup bowl by employi ng the in dex finger and thumb . Th e right hand t hen proceeds to check the contents as was done above and he tastes if desired.
In order to reach the upper right -hand corner of the tray , the patient slides t he dang ling f ingers of t he left hand arou nd the outer edge of the main dish and up to the corner . Hand, wrist and elbow are held high wit h the hand in a natural rela xed position as he moves aro und the plate edge and along the tray surface to make contact wit h the dish edge in the upper corner. Here, the left hand has been used to locate and anchor the dish as the right hand with the fork is used to ex plore and taste the contents.
Location and use of dispensers - To locate the sa It and pepper dispensers, t he patie nt exp lores t he immediate vicinity, slowly and caut iously, keeping his fingers close to the tabl e and semi-extended in order to prevent accidents. If dispensers ca nnot be located he may request help. To use t he dispensers, he places his fingers over the plate , pa lms down . fingers sl ightly apart, and t humb employed at the edge of the dish. He shakes t he salt or pepper through his fingers or he may spill the sa lt into the palm , t hen pi nch and sp read w ith the opposite thumb and index finger.
The sugar bow l is obtai ned in the sa me manner as all other dispensers. If it ca nn ot be loca t ed by the use of t he sea rching techniques. help may
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be requested. T,he sugar bowl is held in the left hand and the teaspoon in the right. With the spoon in the sugar bowl and held firmly with the right hand, the patient moves the bowl close enough to the cup so that the little finger of the right hand touches the cu p. He slides the little finger halfway around the cup edge so that the spoon containi ng the sugar will be directly above it. He spills the sugar into the cup and repeats the procedure if more sugar is desired. If not, he returns the sugar bowl to the table, stirs the sugared contents and returns the spoon to the tray . (The same proced ure may be used in sweetening cereals, fruit cockta iIs, puddings, etc.)
In order to repla ce the coffee or tea cu p on the tray, the procedure will be as follows : by locating the lower right-hand corner of the tray with the right hand and sliding the fingers of t he left hand along the bottom edge of the tray to the same area, the patient then moves the left hand, with fingers bent under, onto the tray and contacts either the saucer or the cup. The thumb and forefinger are placed on the edge of the saucer or the cup . The thumb and forefinger are placed on the edge of the saucer or lightly on the cu p. The cup is located by the right hand and drinking follows. The left hand must remain in its anchoring position until the procedure is completed .
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Location of utensils after use- Emphasis should be put on the importance of returning used utensils to a specific spot so that the same utensils can be found easily when needed and their presence will not hamper the patient's eating activities.
Suggested placement :
Place knife on bread saucer
Place knife on top edge of main plate
Rest fork in main plate as it is being used
Leave the spoon on cup saucer or close to cup as it is being used
Place all utensils not being used between the bottom edge of tray and main plate
Place knife between bottom edge of tray and fork and spoon in their normal position.
Cutting of meat (two procedures) -With the fork in the left hand and the knife in the right, the patient finds the front edge of t-he meat (preferably a corner so as to eliminate an extra or third sliding to free a section from the main piece) . He places the broad side of the knife against the edge of the meat. He digs the fork just inside the knife and into the meat. He then proceeds to cut the meat on the inside of the fork and also under the fork. If a corner was not used in cutting the section of meat desired for eating, an additional cutting at least a hatf inch to.the rear of the fork will be necessary to complete the operation. The cut portion of meat remains on the fork and is drawn to the mouth by the left hand . If more meat is desired, the patient repeats as above. If not, he returns the knife to the tray, parallel to the bottom edge and under the plate . He changes the fork from the left hand to the right, then rea ches for a piece of bread which may be desired as a pusher.
In the second procedure the patient locates the edge of the meat using the fork with the prongs downward and the index finger along the back of the fork. He slightly lifts the fork and slides it over the edge of the meat, inward about % inch. He sti cks the fork into the meat and pro-
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ceeds to cu t around the fork, being carefu l not to cu t the meat loose from the fork. Thi s may be done by cutting % inch from the fork and also by angling the knife's cutting edge away f rom the rear of the fork.
Handling of side dishes (soups, salads, and desserts) - With the soup in the lower left- hand corner of the tray, the patient anchors it with fingers of the left hand by employing the thumb and forefinger around the outer edge of the bowl. He then picks up the sou p spoon in the right hand and carefull y brings spoon to the bowl and proceeds to eat by dipping spoon away from the body.
It has been suggested that all emptied con tainers, bowls or side dishes be moved away so as to eliminate some inconveniences and to enable the eater to have his food as close to him as possible.
Upon finishing the soup, he allows the soup spoon to remain in the bowl. The patient picks up the soup bowl in his right hand (at least 4 to 6 inches in height). He then slides the fingers of his left hand along the left edge of the tray to the upper left-hand corner where he grasps the salad dish on its rim, between thumb and forefinger . The eater slides the dish down to the lower left-hand corner. The left hand again returns to the upper corner along the tray edge to mark the spot and also to guide the right hand with the empty soup bowl to the vacant spot . The patient then removes the spoon from the bowl and places it on the tray alongside the bowl.
When ready for dessert, the patient picks up the main plate in his left hand, and then slides the bent fingers of his right hand diagonally along the tray surface to location of the dessert dish. He takes hold of the dish and slides it to the spot vacated by the rem ova I of the rna in di sh. The right hand return s to the vacant upper right-hand corner with the wrist and also touching the tray corner to mark the spot that will be used as a guide. The left hand then moves the plate above and across the tray until plate edge touches any portion of the right hand and lowers it to the tray. Both hands are then withdrawn correctly to the edge of the tray. The left hand locates and anchors th e dessert dish by employing the thumb and forefinger t o its left edge. The spoo n is retrieved by the right hand and the patient eats.
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MEATS
Meats that can be handled with the fork alone and the aid of a pusher (knife, bread or roll) are:
Hamburgers
Meat loaf
Meat patties
Link sausages
Some cold cuts
Boneless fish
(It is also permissible to make sandwiches from the above meats.)
With the fork held in the right hand in a position for cutting (horizontally) and a pusher in the left hand, patient sizes up his piece of meat by placing the horizontal fork to the front edge and the pusher to the rear or inside edge. The eater then checks the side edge of the meat in the same manner. By digging the fork into the hamburger (as close to the center as possible) and attempting to raise the meat from the plate, the patient determines more thoroughly cutting or chopping it with the side of the horizontally held fork. Then with the aid of a pusher the patient may scoop it up and eat it. On the other hand , if it is possible to cut each bite with the fork when desired, the pusher will be placed at the rear edge and the fork, in a cutting position, to the front edge. The fork is then lifted and moved
inward about Y2 inch. The pusher is removed from the rear and placed
upon the potential bite. The eater starts his cutting motions around the pusher until sounds of the fork meeting the pla te tell him the piece is free. Keeping the cut piece anchored , the fork is brought into position to pick up the cut portion as the pusher is removed.
Additional instructions need to be given in handling meats with bones. Individual preference will play a part, but recommended procedures are as follows.
By thoroughly examining the meat with the knife and fork which are held in readiness for cutting, the patient is better equipped to visualize
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the outline of the bone. He lightly taps the bone from one end to the other, using both utensils to do so. He checks the meat on each side of the bone. This also helps and adds to the mental pi cture. The eater will then stick the fork along one side of the bone. The procedure is continued by having the patient lodge the fork into the meat so that he ca n cut the other portion of meat clinging to the bone. If he knows that another part of the chop or steak needs the same attention, he carries out the same procedu re. After freeing the meat from the bone, the bone is p laced to the side and the remainder of the meat is handled as previously out! ined.
Such meat types as boneless chops or steaks (such as sllced pork , beef, ham or cube steaks) can be handled by the procedure in the section on eating techniques entitled "Cutting of Meats." Or it can be completely cut up and eaten along with other foods with the aid of a fork and a pusher.
The best course to follow in the handling of fish with many small bones is for the patient to use the pusher in the left hand and the fork in the right hand . The pusher is used to anchor the fish as the fork separates the meat from the bones. He proceeds to cut and eat in the manner outlined above in the handling of soft meats.
In eating chicken and other fowl, the patient should thoroughly examine the posit ion of meat on the plate with the fork, which is held in the right hand. The patient is then ready to anchor the meat with the fork . Keepint the fork in place, the fingers of the left hand are brought to the spot marked by the fork and put in the position to pi ck up. The fork is then placed in its normal position on the plate and the fingers of the right hand are moved in to pick up the opposite end of the meat for eating.
Crisp bacon can be picked up with the fingers after having been carefully located with the fork .
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