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Technology and Differently Abled People
Short Chains Of Events
No Sliding Scales
Clear Cause - Effect Connection
No All-In-One Function
Durable And Reliable
It might appear insurmountably difficult to delve into the problems that people with
mental retardation will have when they try to get their bearings in the world of
technology or to use it themselves. Still, it is possible to find a framework that can act
as a bright, guiding light or, if you will, as a theory of technology for these people.
Good technology for people with mental retardation should meet the following six
criteria. These should be the basis for both construction and the evaluation.
Short chains of events
No sliding scales
Clear cause - effect connection
No all-in-one function
Durable and reliable
There really is not anything so difficult to understand here; you can go far on common
sense and natural intelligence. A little help might be needed, however, at first to sort
out the criteria. It is just like the picture on the next page - you might need some
initial help in seeing that the spiral is really made up of circles. Someone has to tell
you that the checked background pattern tricks the brain into making the circles look like
|The picture appears to be a long spiral, but in reality consists of separate circles (go ahead and check for yourself!). You have to take away the background to see the structure.|
Before I focus on the six criteria (corresponding to six of the circles in the spiral),
I would like to discuss the overall picture.
Modern technology - for good and bad
If I were to live my life as a mentally retarded person and had the chance to choose
when in history that would happen, I would without a doubt say, "NOW!". Never
before have the opportunities to live a relatively independent, rich and meaningful life
been so great.
At the same time, however, the technological revolution in our western civilisation has
resulted in a more abstract way of thinking and dealing with the world around us. This
causes great problems for people with intellectual disabilities.
Abstract versus physical scales
Scales are, for most of us, such obvious concepts that we do not even think how
important they are in our communication. We take it for granted that everybody can get an
approximate picture of what I look like from the information that I weigh 165 lbs and am 6
feet tall. If, on the other hand, I would say that I weigh 6 lbs and am 165 feet tall, the
mental picture of that would be absurd for most people. What is it like for mentally
retarded people for whom the concepts "lbs" and "feet" lack meaning?
What kind of mental pictures do they have?
Not so very long ago the length scale was tied to the body very concretely. We carry
different scales with us by using concepts such as foot, handful, stone, arms-length. It
is the same with many other scales. Some Indian tribes measured time in a unit based on
how long it took to cook rice. "I'll see you in two rice-cookings" was for them
a good means of conveying time. Rice cooking time was considerably closer to reality than
the abstract concept of time.
On Greenland, people measure distance in kilometres as well as "sinik" which
means sleep. Thus, distance is measured according to the number of nights one must spend
to cover a distance. In other words, "sinik" is not a pure measurement of
distance nor is it a pure measurement of time. The unit of measurement depends upon the
weather, season, age and physical condition of the traveller.
There was a time when most people knew what an acre was: it was the area that could be
sown with a barrel of seed. Since many had the practical experience of sowing by hand,
they knew in their bones what that unit of measurement was. It is difficult for us to
understand the size of an acre in this manner today. Instead, we learn how many square
metres/feet it contains. When we need an object of comparison to tell how big an area is,
it is more natural for us to use a football field than an acre since it is easier for us
to have a mental picture of the size of a football field.
Since those with mental retardation have problems with abstract thought, the transition
form concrete scales to abstract ones is of even greater difficulty for them than it is
for us. But even we have problems. How many of us can imagine what a kilojoule is without
using a conversion table that tells that the energy in a lump of sugar is equal to about
so many kilojoules, or that we burn up a certain number of kilojoules in an hour of
Time versus space
The three dimensions of space are considerably more concrete that the one dimension of
time. We ourselves are three-dimensional. We can see and put on three-dimensional objects.
We can hold out our hands and compare and measure and agree on the size of something. It
is not as easy to measure or compare how long something lasts in such a concrete way.
Instead, we have to use clocks.
It is true that humans have built-in clocks: 24-hour clocks, hunger clocks, etc. The
most dependable of these is probably the 24-hour clock, while the hunger and sleep clocks
are more variable. As we all know, our experience of how long a second or an hour lasts
can change from one time to the next.
Still, we chase time in our part of the world to such an extent that we barely have
time for anything else. We have created a society built on concentration and closeness
in time. We eliminate geographical distances by means of quick communications
including telephones. Those who deviate find it difficult to manage.
In the past, society dealt with mentally retarded people by putting them in special
institutions where they were taken care of, fed, clothed and kept clean. Today the
cornerstone is independence in living and working. This has been extraordinarily
successful. But the problem of understanding time is often the main limiting factor.
People with cognitive impairments do not achieve independence even when they can perform
all the individual steps themselves, if someone has to stand beside them and tell
them when it is time to perform the next task.
The appearance of different types of temporal aids for people with mental retardation
is no coincidence. More frequently activities are carried out on an individual basis and
not in groups as it was in the time of the big institutions. This places more demands on
the individual. He has to be able to handle different types of time measurements. For
those who are mildly retarded it is often most important to know when activities
are going to happen, while for those who are moderately to severely retarded, it is more
important to know in which order different steps are to be carried out or how
long an activity will last.
Alternative means of measuring time
Those who are moderately to severely retarded, who live for the most part in group
homes, try to understand time in many different ways. Personnel come and go according to
different schedules. The residents are well aware of who comes in the afternoon and
evening. They know the unique habits of staff members and can use them as a kind of clock.
If Agnes leaves her purse in the staff room, she will not be gone for long. If Curt
goes out without his jacket, he will be back soon. If he goes out with the trash, it will
take about so much time. If Sven takes a packet of cigarettes, he will be gone longer than
a go-out-with-the-trash-period. When the person on night duty snores loudly, it means one
can go back to sleep again but when she softly whistles, it usually means it is time to
I believe that many people with mental retardation measure time in trash bags,
cigarettes, readings of newspapers, purses and snoring. The importance of personnel
routines as an implicit clock is widely undervalued.
So far the discussion has been about regularly recurring events. This makes them
understandable. Unexpected events, on the other hand, can easily cause anxiety among those
who have difficulties understanding time. How can one be expected to handle a situation
when one does not already know the difference lengths of time it takes to go to the
cottage for a holiday, to take a day-long field trip, to take a new class or go to the
corner shop? CERTEC's motivation in developing time-measuring devices based on how people
with mental retardation understand time has been an attempt to relieve anxiety by
increasing a sense of time security. It is not a matter of burdening people with cognitive
impairments or brain damage with the added demand that they must understand time too.
Our ambition is to contribute to a genuine orientation in time so that those with
mental retardation need not be unexpectedly moved from one activity to another. CERTEC's
working model has been an attempt to convert abstract time into a length (quantity) scale.
Through pedagogical training one can awaken a person to the awareness that "a little
showing" on the clock means "soon", while "a lot left" on the
clock means "it is still quite a while".
The Blue Clock
You might need to use your imagination to understand how difficult hour
clocks can be for the mentally retarded. Imagine that you travel to a place called Blue
Island and there you are introduced to the idea behind the "Blue Clock". This is
a device that the inhabitants use to tell time, but it measures time in shades of blue,
not in minutes and hours. As shown in the advertisement on the next page, those on Blue
Island can buy clocks by mail order.
How would it feel to sit with "The Blue Clock" in hand and,
based on the degree of blueness, try to understand a TV guide? How would one be able to
show up for the prize trip to the West Indies on June 5 at such and such blue time? In
this situation, all of us would probably be continually comparing the blueness on
"The Blue Clock" with the departure times or the TV guide. For the West Indies
trip we would, to be on the safe side, go out to the airport when it was only light blue.
This mental exercise may seem a bit strange, but it more than likely illustrates
exactly how it is for many individuals with mental retardation when dealing with ordinary
clocks. I know a man who knows where the hands on the clock are when it is 7.00, which is
the time he is supposed to leave to go bowling. But because he does not understand the
clock system, he can sit from 5.00 and look at the hands to be sure that he sees when the
right configuration occurs.
Well-thought out system
It is a matter of making life easier for those with cognitive impairments by trying the
best we can to develop well-thought out systems. It may concern the systems used in
technology, for example, that the on-button is always green or that oral operating
instructions for machines can be gotten by pushing the yellow button.
It can also be a matter of always working according to a certain method. In the TEACCH
method (Treatment and Education of Autistic and related Communication handicapped
CHildren) everything is done form top to bottom and from left to right. This pattern is
used in different activities.
"Standardisation" is sometimes considered a dirty word symbolising all that
is mediocre, grey and bureaucratic. But for people with mental retardation who have
difficulties generalising, everything standardised is of great value. If you have once
learned that the men's room has a capital "M" on the door, you will not find it
the day that someone has exchanged the "M" for a stick man or some other
advanced, abstract symbol.
Similarly, it is important that the hot water tap is always marked with red and is
positioned to the left. This should also be the case for mixer-taps (they really are far
too complicated). It is especially important in showers where the water temperature is not
automatically regulated. Many who are retarded have either burnt themselves or taken an
unexpected, ice-cold shower after exercising, which can frighten them the next time. An
unexplained resistance to an activity can sometimes have such a simple explanation.
Standardisation in the form of fixed times and days for TV and radio programmes are of
great value for mentally retarded people who have a poor understanding of time. It is
valuable to have a common frame of reference when choosing a time to meet. "I'll see
you right after the evening news" is often better than "I'll see you about
Unique or general?
A person with mental retardation can have problems in many areas, for example, in
sorting clothes, making a shopping list, running a microwave and a washing machine. One
way to attack this problem is to try to find simple devices or methods for each
Another approach is to try to find a technique that can be a bit complicated but can be used in many different areas and which is carried out by everybody in the same way. The obvious advantage is that when the general technique is finally learned, it can be used in many situations.
This makes all the effort that goes into learning it worthwhile.
Bar code reading is an example of one of these techniques. It is easy to learn how to
use the bar code reader and bar codes already exist is many different situations. Someone
who is unable to read could get oral information about a product or appliance from the bar
code. He could independently do the wash with its help and it would be a means of finding
the desired TV programme or leisure time activity. Systems that program the radio to play
certain types of music already exist for people who are considered to have normal
intelligence. One can program in a profile of interests. If it consists of "dance
music" and "ballads", the seeker searches through what is offered and
selects only that type of music.
I sometimes think that we staff members go too far in our attempts to train those with
mental retardation to be independent. This is especially true in situations where we
should have put our efforts on compensation instead of training. I remember how we tried
year after year to train our pupils to tie their shoes. We had all kinds of shoe-tying
boards imaginable, and both the pupils and teachers hated these lessons. Then came the
arrival of shoes with Velcro straps and all of those tying boards were put away. No one
seems to miss them. We were all very happy when the technology (Velcro straps) appeared.
Why couldn't we, ourselves, have come up with the idea of putting our efforts towards
finding a new technique, ie, another way of fastening shoes, instead of just practicing
I find the practice of training retarded adults to be independent to be contradictory.
In each situation we should automatically think of technical solutions as an alternative.
These solutions should be such that a person who is cognitively challenged can manage
the technology on her own as much as possible. After all, she is the one who is the best
motivated to do it herself. Compare this to how successfully the patient's prescription
drug handbook has sold and is meticulously read by both patient and relatives alike.
About the need for aids in caregiving
As programme director, I have often run into opposition from care providers when I have
decided to change the living arrangement to make it more understandable for the residents.
It has often been a matter of putting up pictures on cupboards or walls for those who
cannot read or marking the buttons and switches on different appliances. The staff feel
that the flat will resemble an institution if pictures are put up all over the place. As
someone once stated, "It's not normal to have it that way in an ordinary home."
This got me thinking about what was "normal", and if we, with so called normal
intelligence, have any "intelligent-support" devices. Within a couple of hours I
listed about fifty of them. Here are some of the items:
Intelligence and judgement aids for those with "normal
Washing instructions on
clothes. One no longer needs to know the different qualities of material, how colourfast
they are, etc.
Expiration date on food. Before it was necessary to be able to smell, feel and see the meat to decide if it was edible. Today we just look at the expiration date on the package.
Thermometers (meat, outdoor, indoor, to take you temperature . . . ). It is no longer necessary to look and feel.
Colour analysis that tell what colours suit you best.
Dashboard with speedometer, warning lights for the oil, battery, etc.
Souvenirs, to remind us of places we have visited.
Reviews of film, plays and books so that we do not have to make our own judgements.
Cookery books with coloured pictures that show us how.
Weight Watchers for adults and weight scales for infants.
Warning signs along the road. You do not need to spend years studying the elk's habits. The sign will tell you: ELK next 500 metres.
National and municipal standards for such things as gold, drinking-water and electrical products.
Completely automatic cameras so one no longer needs to judge distance and light.
Weather forecasts so that one does not need to go out at night to study cloud formations, the colour of the sky and the swallows flight - just sit in an easy chair and watch the news.
Thermostats on irons.
All types of guarantees. You no longer need to learn where the typical rust spots will appear on a Volvo 240.
Pre-set buttons on radios and systems that search for and find your favourite programmes automatically.
Fuse boxes. There is no longer a need to keep track of how much electricity is being used. The fuse box knows.
Pop-up thermometers on chickens. When the button pops up the chicken is done.
Quality auctions which guarantee that you do not go broke buying a fake Matisse.
Photographs and video films as reminders.
Clocks, scales, maps compasses, tape-measure, etc.
These aids for those with normal intelligence are so taken for granted that we seldom
think of them as such. The timesaving advantage is obvious. Thanks to them one does not
have to put the time and effort into learning about so many different areas. Some can be
of use to people with mental retardation, but many of them are too abstract. This results
in a contradictory situation in which those who are most in need of intelligence aids, ie,
the mentally retarded, have fewer and often less well-adapted aids than the rest of us.
I briefly outlined natural intelligence and technology for the retarded user in the
introduction to this chapter. Now is the time to focus on the more structured aspects: the
six basic criteria.
Short Chains of Events
It is important that the chain of events is short. Think of the difficulties
all of us have in starting a VCR that we are unfamiliar with. Even when we have a rather
good idea of which buttons to push, nothing will happen if the sequence is wrong. The
longer the sequence, the greater the chance that something will go wrong.
Discovering the mistake afterwards is not of much help either. The only thing to do is
to start all over.
Even in the case where the chain of events is only three links long, and the risk of
making a mistake is 50 percent at each step, you will be right in only one of eight
Sven is a mildly retarded man in his 30s. He shares a flat
with three friends. He works at a little factory 6 miles from his house. Sven's biggest
worry in life is that he does not have a girlfriend. He is afraid that he will soon be too
old and so takes every opportunity to go out dancing in order to meet women. Sven loves to
dance and has a pleasant personality. Many are surprised that he hasn't found someone yet.
Most likely, Sven's failure has nothing to do with his performance on the dance floor
but is the result of other factors. To ascertain what the real problem is, I will try to
analyse a dance evening and illustrate the difficulties.
A simplified version of the chain of events is shown here.
Since Sven has problems telling time, there is a certain risk that he will be late
every time he has to change buses. In addition, he easily mislays his bus card, adding
another element of risk. The dancing, conversation and contacts, on the other hand, are no
problem at all for Sven.
His memory is not the best. Even when Sven meets a woman who is interested in him, he has forgotten her name the next day. He does not remember her telephone number or where she lives either. In spite of it all, they may have agreed to meet in a week to go to the cinema. Sven spends the whole time thinking the woman will get in touch with him, but in many cases she has the same problems. In this way, these dance evenings end with two people, who like each other, sitting and waiting for someone they don't know the name of to call and make a date.
There are, of course, many ways of helping Sven in this situation. One is that a staff
member from the group home goes along to assist Sven through the difficult parts and in
this way help him increase his independence. But Sven is adamant about not having anyone
from the staff along - it would worsen his chances of making an impression on the women
who interest him. Sven obviously wants to show that he can handle the situation himself.
Another approach would be to practise the steps that are difficult back at the group
home. This has also been tried, but it appears that it is hard for Sven to use any of
these exercises in the actual situations.
A third way is to reduce the number of links in the chain of events with the help of
By giving Sven access to an aid for telling time in the form of a quarter-hour clock,
the risk of missing the buses would be significantly reduced. In addition, if the bus card
is fastened with a safety pin and rubber band, another element of uncertainty disappears.
Then when Sven gets a calling card with his name, address and telephone number to give to
his new love, even that link in the chain holds. The calling card is the most important
aid since Sven's failure rate in performing this step is 100 percent. There is no point in
solving all the bus problems if he is still unable to be contacted by the woman.
With three simple aids, we have succeeded in reducing the number of links in the chain
from nine to, in principle, none. If a problem remains, it is considerably easier to
concentrate practice on one step instead of the whole chain.
Once I just
happened to observe a mildly retarded man desperately trying to get a commuter train
ticket from an automatic ticket dispenser without success. The ticket cost 50 SKr, which
meant that he would have to put in five 10-crown-bills in a row. Each bill had to be on a
certain side and inserted in the right direction. The odds of succeeding if one does not
understand the principles are only one in twenty. If one has short-term memory deficits
and so cannot remember how to turn the bill, the chances of getting a ticket from the
machine before the train leaves are very poor. He was unsuccessful and the train left
Had the dispenser taken 10-crown coins, the problem would have been nonexistent.
When analysing technology in the home, it is easy to find several examples of
appliances and devices that require many operational steps. These need to be carried out
in the correct sequence in order to work. Remote controls for televisions and videos are
frightening illustrations. They are made up of many buttons with abstract symbols and the
buttons have to be pressed in the right order to get a picture on the screen. For people
with mental retardation, it would be best to have the buttons for each channel on the
television itself. It is almost impossible to find these kinds of TV's in the shops today.
An alternative would be to come up with a simpler model, the Model-T Ford of remote
controls. Many elderly as well would rather have a simplified remote control with only
three buttons: one to turn on the TV and easily choose the channel, one to turn it off and
one for sound. An engineering student here at CERTEC has developed one with only two
buttons. He chose to eliminate the sound control to make it even easier to use.
|A scary example of the traditional remote control beside a simplified remote control designed by an engineering student participating in a CERTEC course. The simplified version has only two buttons: an on-button (with which one can change channels too - just continue pressing) and an off-button.|
A long chain of events can result in negative consequences in what even appears to be a simple context. One morning the mother of a resident called to say that her daughter, Lisa, had to stay home from work because she was exhausted and had caught a cold. Lisa had been to the cinema the evening before and when she arrived at the group home the door was locked. Lisa put her key in the lock and turned it but the door would not open. She pushed the door but it still would not open. She tried different ways of pushing and pulling the door while turning the key but was unsuccessful. So she went to another flat where she knew there were personnel but that door was locked as well and she had no key. She could think of no other solution than to go home to her mother's. It was 12 miles away and Lisa had no jacket on a cold, windy November night. Lisa's mother woke up to a knock on the door at 3.00 am and there stood Lisa in her thin slippers, frozen to the bone.
The next evening a staff member tried the lock. It turned out that opening the door
involved techniques that had to be co-ordinated in a certain order. While pulling on the
door, one had to lift the handle and turn the key. If not, the door would not open. It was
not easy for someone on the staff who intuitively could figure out how to approach it.
Lisa had the right approach in trying the different steps in opening the door, but she
was unable to get them in the correct sequence. As a result she was forced to walk to her
mother's in the middle of the night. Unfortunately, the experience frightened her so that
since then she has avoided leisure activities for fear of being locked out.
The Non-complaining generation
Bodil Jönsson, my co-author, has launched the non-complaining generation club. It has
no chairperson, no membership list, no fees, no meetings. The only thing you get when you
become a member is a little green fellow inside you, who - as soon as you start to
complain - raises his head and says, "Aren't you a member of the Club?" Then you
must start again constructively and admit that little progress can be made by complaining.
Instead something should be done, measures taken or good examples found that can serve as
What are some good models of technology that can be found in the home? Well, one
example is the refrigerator. In all my years as a director, I have never encountered a
person with mental retardation who has had problems with the refrigerator. If it is milk
you want there is no need to push a lot of buttons in a certain order or to use a remote
control. Just open the refrigerator door and there it is!
No Sliding Scales
Many years ago I knew a mildly retarded man who was scared
to death of electric shavers. Since it was electric, he thought that it would give him
shocks. After talking it over with him for months he was ready to use the shaver under the
condition that someone else would hold it when he shaved. After a year, he was ready to
try it on his own. But in addition to shaving his beard and sideburns, he shaved off the
hair above his ears.
We were in the position of trying to explain to him in a clear and concise way where his beard ended and his hair started. This was much more difficult than I had expected and we finally had to give up. We just had to accept the fact that in the future, one of us had to be with him when he shaved to tell him when to stop.
Beard - sideburns - hair: this is an example of the concept "sliding scale".
In the area of personal hygiene there are many examples. How much trimming of finger nails
is needed so that they are not "too long"? How long does it take to brush one's
teeth "properly"? Where does your face end and you throat begin?
People with mental retardation are not the only ones who have problems with sliding
scales. Most of us do not like sliding scales either and try to avoid them. We do not
always succeed. Those who suffer from burnout often have jobs that lack clear limits as to
how much is to be accomplished in a day. These jobs can be found in health care, other
forms of caregiving, nonprofit organisations, those who are self-employed, managers,
researchers and politicians. No matter how much you work, there is always someone (if only
yourself) who thinks more should be done. Many wrestle with sliding scales.
Dentists have introduced an ingenious way to replace the sliding scale "brush you
teeth properly". After a patient has sucked on a tablet that turns all his teeth red,
he is asked to brush until they are all white again.
Amateur cooks have difficulties with cookery books that use vague concepts such as
"a pinch of salt", "medium-hot oven", "beat until fluffy",
etc. They want to have the measurements clearly expressed as "a teaspoon salt",
"a 200° oven", etc. Modern cookery books have taken this uncertainty into
consideration. Besides writing out the exact measurements, they show all the steps in
order and finally they print a beautiful, full-coloured picture of the finished dish.
Someone at the group home fixes a meat stew that everybody thinks tastes really good. The cook is highly praised. A few weeks have gone by and it is time to sit down together to plan the menu for a Sunday group dinner. The staff try to get the residents to give a variety of suggestions but get only the usual "spaghetti and meat sauce", "pancakes", etc. Deep down inside there are many who would like to have that good meat stew but are unable to express it. You can't just say "stew" because there are so many different kinds (some of which are not at all appreciated). Nor can you say, "I want to have that good stew that Stina fixed three weeks ago and had meat, carrots and leeks," because you have forgotten that it was Stina who fixed it or because it is difficult to list the ingredients.
If, in the spirit of the non-complaining generation, one searches for something fairly
well defined in the world of food, one might come up with waffles as an example. A waffle
is a waffle. There is no sliding scale between waffles and pancakes. No one would think of
calling a waffle a square pancake. Waffle toppings are also well defined: they are
something sweet such as syrup, preserves or whipped cream. One always knows when ordering
waffles that there is no worry of getting onions or pickles or some other totally
There is a certain security in waffles, hamburgers, roast beef, tomato soup, beans and
toast. The same security is not to be found in stews or casseroles. How are stews clearly
defined? One way is to consistently remember to give each stew a name. Once named,
it has to always have the same ingredients in the future. You have to be a real stickler
about this. If the residents are especially fond of "Bertil's Stew" which in
addition to meat contains carrots and tomatoes, peas cannot be substituted for carrots the
next time the stew is prepared. Then it is no longer "Bertil's Stew".
How is the general problem of sliding scales solved? The cookery book described above
gives a hint as to how it should be approached. Vague and diffuse expressions must be
replaced with clear and well-defined ones as far as possible. How the sequences and items
are represented must be concrete for those with mental retardation in particular. The
CERTEC clock presented in the introduction is a good example of this: it is concrete (uses
length to represent time) and it has a clear, built-in definition of what constitutes
different parts of the day, ie, evening or night.
Bengt lives in his own flat and works at a supermarket. He can take care of most things in the flat and only needs help in filling out forms and such. Sometimes Bengt calls me up and says that he doesn't know if he should go to work because he isn't feeling well. I asked him if he had a temperature the first time. He didn't know because he couldn't use a thermometer.
Bengt did not understand the temperature scale and how it was connected to being sick
or not. That meant that every time he was feeling out of sorts, one of us had to help him
take his temperature. In order to give Bengt a chance to do it on his own, two engineering
students at CERTEC developed a thermometer for people with intellectual disabilities.
|There is no temperature when the green light is lit. The yellow light indicates a low temperature while the red one warns of a high temperature.|
Now when Bengt calls and says that he is sick, I can just ask which light is lit and
then I have an indication of how serious it is.
TEACCH - one more time
The method "Treatment and Education of Autistic and related Communication
handicapped CHildren", which I mentioned earlier is more than just an excellent
example of ordering activities in a consistent manner (always from the top down and always
from left to right). It also does a very good job of defining what would otherwise be
vague and sliding. Instead of practicing, "Vacuum the carpet until it is clean",
a yellow powder is sprinkled on the carpet and one tries to, "Remove the yellow
powder with the vacuum cleaner." A gym exercise can be practised in the same way by
saying, "Take the balls out of the can without bending you knees and put the balls in
the basket. When the can is empty, you are finished." Compare that to the ordinary
directions, "Try to stretch your arms as far down as you can!"
The Nimbus School in Lund, Sweden has achieved good results using the TEACCH Method
with autistic children and adolescents. I believe that this method contains quality
techniques that can be used with other special populations. Knowledge of it deserves to be
spread. Through its use one can approach sliding scales in a considerably better
thought-out and methodical manner than what has been done so far.
Books on the TEACCH Method are published by Nature och Kultur.
Part 1 : PEP-R , 1992 and Part 2: Teachings Strategies for Parents and
Professionals, l993. Part 3: Teaching Strategies for Children with Autism and Part
4: AAPEP for Youths and Adults, 1994. The book Over and Over: Teaching Methods for
Autism from the same publisher is also based on the TEACCH Method.
Clear Cause - Effect Connection
Gerd had moved to the other side of town, so I hadn't seen her for a few months. One morning when it was pouring rain, I met her walking from the square, her hair and clothes drenched. I asked her how things were and if she had been visiting someone so early in the morning. It turned out that she had withdrawn money from the cash machine. Since I knew that there was a cash machine quite close to her new home, I asked if it was out of order. She was quite surprised and after talking about it I realized that she did not know that all the cash machines were connected. She thought that since she had received her cash card code at a particular bank, she had to get her money out of that bank's cash machine too.
This example shows how difficult it can be to understand how a system works. How
could Gerd know that all cash machines were connected?
The effects of technology can sometimes give the impression of being downright magic.
Think of a small child's wonder at being able to touch a switch at one end of a room that
can turn on a flood of light at the other! We adults know that an electrical wire
runs from the switch to the lamp, but if we think about it there is nothing visible
that shows us that. These kinds of hidden connections result in continual problems for
people with mental retardation.
Many retarded people have difficulties with jumpers. How do you know when it is inside
out and how do you tell the front from the back? For the front-and-back problem,
manufacturers try to give a clue by putting a tag on the back inside collar. Once the
jumper is on, though, the tag is no longer visible. It is not obvious to a person with
cognitive difficulties that it is in the back because the part of the collar he will look
at is the front. It is there that he should have the tag.
Stoves are usually very difficult for those with mental retardation to figure out.
There are four hotplates on a square. The knobs that control the hotplates are in a row on
the front panel. How does one determine which knob goes with which hotplate? The
manufacturers try to give clues by using big black positioning dots on the knobs but this
is not at all adequate. Either the hotplates should sit in a row corresponding to the
knob's placement or, better yet, the control should be directly next to or under the
hotplate (see the illustration on the next page).
|An ordinary stove (B) has four hotplates but there are six control knobs on the front. The controls are in a row but the hotplates are placed in a square. In addition, the controls do not click into place but can be turned both clockwise and counterclockwise. The ideal stove (A) has the hotplates in a row with a control and light right next to each one. This clearly guides cooks with mental retardation (and the rest of us for that matter). The controls have fixed heat levels and the stove turns off automatically.|
The personnel can avoid many of the limiting transparency problems with appliances and
machines. The best way is to think about how understandable the new item is for the
retarded before every purchase is made. If a washing machine is bought that the
residents are unable to use, it will be there for many years anyway. During that time the
staff will have to take care of doing the wash, which was not the initial idea.
The non-complaining generation - again
The non-complaining generation - what do we do then for those areas for which no
products with a clear cause-effect connection exists? First we should, with increased
clarity, define the problem and suggest solutions. We should try to be a strong advocacy
group that, at least unofficially, evaluates products according to how well they meet the
Short chains of events
No sliding scales
Clear cause - effect connection
No all-in-one function
Durable and reliable
During the transition period we will have to live with the old, unclear products. The
staff will have to make compensations for a product's imprecision by explaining and
clarifying what effects a given action will have (instead of assuming that it is obvious).
|Microwave oven - an example of a user-friendly, precise technology. There are even microwaves with only two buttons.|
No All-In-One Function
If I was to choose the best example of bad technology, I would without a doubt choose
the common clock radio. It rings and plays at night, on holidays, in the evening and every
other inappropriate time except in the morning when it is supposed to. I have heard
complaints from neighbours, work supervisors, relatives and staff about the consequences
of incorrectly set or difficult-to-set clock radios.
|1. Set alarm time for awakening to radio
Set the alarm time with TIME SET button,
H to set the hour and M to set the minutes,
while holding down ALARM /A/RADIO
to the time you want the radio to wake you.
Set the buzzer alarm time with the TIME SET
button, H to set the hour and M to set the minutes,
while holding down the ALARM /B/BUZZER/
(to the time you want the alarm signal to
To advance the minute digits rapidly
Keep the H and M buttons pressed while holding
down the ALARM /A/RADIO/ or /B/BUZZER/
2. Set the function selection switch to the
For radio alarm only:
I shudder at the thought of the switch-over from summer time to regular time. It takes
many days before everybody can get to work on time. Adults with mental retardation are
unable to set the alarm and, unfortunately, neither can the personnel. In some residences
a person is assigned the job of "clock responsibility". They are called upon
when everyone else has given up trying to sort out the mess. There is nothing wrong with
alarm clocks and there is nothing wrong with radios. The problem is in trying to make the
two into one. What really is most surprising is that new clock radios are constantly
turning up in group homes. Why?
Clock radios are not the only machines that try to combine all in one. There are many
more. The results, for the most part, are incomprehensible. A friend of mine bought a
super vacuum cleaner a while ago. Besides vacuuming the floor and drapes, it could wash
carpets and sofas and perform a thousand other tasks. The problem was that for every task
a special attachment was needed. To attach one, you had to carefully read a user's manual
that was as thick as a brick. I do not think that my friend ever used any of the vacuum
cleaner's special features since the time she tried to clean her thick-pile rug.
Look at yourself and your friends. How many of those super-appliances, super-food
processors and super-microwaves do you use for only one task even though, according to the
sales person, they could do everything - even work miracles?
Durable and Reliable
When I worked at a student group home for young retarded people with behavioural
problems, I realised how important it was that an environment be adapted to tolerate rough
handling. The doors of the group home were so thin that after only a few years they were
full of big holes. The impression it gave to the residents, relatives and staff was one of
dilapidation and shabbiness. There were other details in the building that were clearly
undersized such as the outlets, switches, furniture, light fixtures, etc. One particular
problem was with the taps.
One of the residents broke the tap in the middle when he was upset. It could sometimes happen many times in a week. Beyond the great cost of a plumber coming in to change it, this caused much irritation between the staff and the resident. We tried in every way we could to solve the problem with pedagogical and psychological methods. When that did not work, we tried the unpedagocial and unpsychological. Nothing helped. It went on for many years. One day a caregiver got so angry that he took a hacksaw and sawed off the tap. He then welded the parts of the tap together to a rubber hose and two hose clamps. During the next tantrum, the pupil grabbed the tap and tried to break it but it wouldn't give. It just bent because of the rubber hose and then returned to its original position. I remember how surprised he was and I waited to see what would happen next. But there was nothing more on that occasion. The tantrum stopped short and he left. During the next few days he made a few attempts at breaking the tap, but then the attempts stopped altogether. We did not notice that any other object replaced the tap. Even if it had happened, the new one would probably have been less irritating and cheaper.
Durability is important. I remember what the LP records looked like when record players
had pickups. After only a few weeks of playing the records were totally destroyed. Such
fine movements were required to operate the pickups that those with poor fine-motor skills
could not do it. CD players have been a real lift for all of those who have difficulties
Aids for the disabled must be durable as well. You do not buy a fragile communication
device for £5,000 if you know that the one who gets it will drop it on the floor the
There are many of us who check once or twice every morning to see if we have turned off
the stove and other electrical appliances. We do not consider ourselves neurotic because
of it. But if a good portion of our existence was taken up with worrying about things we
might forget, we would certainly think that it had grown out of proportion.
This is the situation, however, for many people with mental retardation. They have
great difficulties with short-term memory. For some it means that they must devote an
exorbitant amount of time to not forgetting things. The person who is absorbed in
remembering has, unfortunately, little mental energy left for learning something new - no
matter how vital it is.
That is why it is important to unload as much of that "memory ballast" as
possible. This can be done through different kinds of reminders or by machines that turn
themselves on or off automatically.
The memory substitute itself cannot be too difficult either. The coffee machines in
many staff rooms have timers. The standard timer has a continuous dial that most people
with mental retardation cannot manage. CERTEC has developed a timer for coffee makers that
turns off the current twenty minutes after the timer button has been pushed. It works
extremely well in the group home.
Stina lives in a group home with three friends. She has on several occasions in the last year been close to setting the flat on fire due to her poor short-term memory. It happened a number of times when the telephone rang while she was ironing. Stina left the ironing board and it wasn't until the clothes started to smoke that she returned from the telephone. Most of the time it was her friends in the flat who turned off the hotplates or coffee maker or tap. Stina herself was not very bothered by these incidents, but her friends were considerably more concerned. The staff at the group home solved the problem with the iron by purchasing a new one that turned itself off automatically.
A group home was going to have a fire drill. One caregiver held a cigarette under the smoke detector so that the alarm went off. He asked the residents what they should do when they heard that sound. One of them fetched a newspaper. He stood under the smoke detector and started to wave the newspaper back and forth. The smoke detector was mounted directly over the toaster, which set off the smoke detector almost every time the toaster was used. Someone from the staff usually took a newspaper and fanned away the smoke so that the alarm would cease. I could picture for myself how in case of a real fire, five residents would be standing under the smoke detector, waving newspapers instead of getting out of the flat.
Two engineering students here at CERTEC were assigned the task of designing a talking
smoke detector. Each resident has a speaker over his or her bed that tells that person
exactly where to go in case of a fire. The message is delivered by a familiar voice and is
repeated as long as there is smoke. There is a big difference in receiving oral,
individual instructions instead of the traditional loud alarm. This is also a means of
playing down the emotional impact of fire drills and we could schedule them more often
than we do today.
Table of Contents
2. Natural Intelligence
3. Artificial Intelligence