The Indian Journal of Occupational Therapy : Vol. XXXIII: No. THE EFFECTIVENESS OF COGNITIVE SKILL TRAINING ON PERFORMANCE IN DRESSING IN THE MENTALLY RETARDED ANITA BEHERA INTRODUCTION Mental Retardation has been defined and ranamed many times through out history. The most recent change in the definition was adopted in 99 by the American Association on Mental Retardation. "Mental Retardation refers to substantial limitation in the present function. It is characterized by significant sub average intellectual functioning, existing concurrently with related limitation in two or more of the following applicable adaptive skill areas: communication, selfcare, home living, social skill, community use, self-direction, health and safety, functional academics, leisure and work. Mental Retardation manifests before age eight. Because of the cognitive deficit the mentally retarded when left to his own device is unable to utilize the cues and stimuli from his surrounding as appropriate guide to behaviour (Leland, 964). Efficient therapy programme through the use of goal directed activities plays an efficient role for acquistion of useful skill. The present study was undertaken assuming that self help skills can be improved by training in cognitive skills. Generalization of skills has also been emphasized. OBJECTIVE The objective of the present sudy was to determine the effectiveness of cognitive skill training on self help skills in mentally retarded children. Literature Review It is encouraging that various studies have been and are being done in this often confused field of Mental Retardation and ofcourse various opinions have emerged. CORRESPONDENCE: Dr. Anita Behera, (O.T.) Deptt. of Occupational Therapy, COAHS, Manipal-5769. The paper was presented with AIOTA Trophy for Best Paper on Mental Health at XXXVIIIth National Conference of AIOTA at Bhubaneswar in Jan.,. Douglas and Peters, 974, stated that normal attentional functioning can be attributed to an individual's ability to utilize prior knowledge to guide the perception and cognition of present events as well as an ability to impose voluntary control over current perception and cognition. "Cognitive modifiability in retarded adolescents: Effect of instrumental enrichment"-in this investigation by Reuven, Ya'acov, Hoffan, Miller (98), an attempt is made through an intervention srategy to compensate for a lack of mediated learning experience by exposing subject to a series of tasks to modify cognitive function in which they are deficient. The results are encouraging and indicate that a systematic approach to mediate learning can enhance the cognitive development. In their study on "Learning, memory and transfer in profoundly, severely and moderately Mentally Retarded persons" Norman R. Ellis, Joseph R. (984), have compared the findings in functional skill training in a group of moderately and severely retarded. Higher functioning patients usually learned more rapidly than lower functioning patients. Anderson (988) in his paper "Understanding the cognitive deficit in Mentally Retarded" postulated that cognitive deficit is not the only factor involved and that the climate and tactics with which individual is reared are still important in examining the final actions. Primary source of retardation is cognitive deficits. METHODOLOGY Design A same subject before-and -after design was used, as the study wanted to look at the effects of cognitive skill training on dressing skills in mentally retarded children. By using this design, the result of two sets of score could be correlated and assessed for statistical significance using a paird t-test. Participants The study was carried out over a period of five months. The IJOT : Vol. XXXIII : No. 5 Aug. - Nov.
subjects were students of Thakur Hari Prasad Institute (THPI) of Mantally Retardeds, Rajahmundry. Data were collected from 5 children among which were males and 5 were female child of age group 5-8 yrs. All 5 children were diagnosed to be moderately mentally retarded (IQ-5-49). Assessment Assessment was done by an ordinal scale developed and in use at THPI. The following areas were assessed. Cognitive skill- Body image Color concept Size Spatial orientation Dressing skill code : - Makes no atempt - Attempts, Doesn't succeed - Succeeds slowly or awkwardly - Succeeds, normally Assessment was done in a quiet room. Initially the therapist had to build rapport with the child. Gradually the child started to co-operate. For assessment of the body image the child was asked to point to minimum three parts of his body and tell their use. For assessment of color the child is asked to sort, match and identify primary colors. Concept of size was assessed by asking the child to sort, match and identify big and small objects. Spatial concept was asessed by asking the child to discriminate up/down, in/out, front/behind. Dressing skill was assessed by making the child wear and button the shirt. It took 45 min.- hr. to assess each child. According to the performance of the child scoring was done. Therapeutic Intervention After the careful assessment goals were set and a therapy programme was planned for a period of 5 months. It varied from child to child according to the need. Therapy was planned in two sessions, each session lasting for -45 miniutes. Each activity was broken down into simplest steps. Each step was demonstrated by the therapist and followed by patient's own endeavor. Activities were changed frequently enough so that the child does not nave time to become disinterested. Gradation of activity was done by proceeding from simple to complex. Known to unknown Concrete to abstract Whole to part Structured to unstructured. A variety of teaching materials like flash cards, picture book, peg board, human puzzle, color cubes, shape board, wooden blocks etc. were used. Attempt was made to maintain consistency in the teaching pattern by using same material, in the same set of circumstances each time. Because a change in place may well upset their concentration and working capacity for a disproportionate amount of time. At the end of five month of therapy programme reassessment was done using the same scale and result was documented. Statistical Analysis Table : Pre-Therapy Assessment Sl. No. Body Image Color Size Spatial Dressing Concept Orientation 4 5 6 7 8 9 4 5 IJOT : Vol. XXXIII : No. 6 Aug. - Nov.
Table : Post-Therapy Assessment Sl. No. Body Color Size Spatial Dressing Image Concept Orientation Fig - 4 5 6 7 8 9 4 5 Fig - Color Concept Table : Correlation of dressing skills with variables Variables Average score r value p value Body Image.5.65 <.5 Color Conecpt..67 <.5 Size.56 <.5 Spatial Orientation.9.79 >.5 Body Image 4 7 Table : shows that body image, size, color concept are significantly correlatd with self help skills. But spatial orientation does not show significant correlation. Table : 4 Comparison of pre therapy and post therapy scores Fig - 4 7 Variables t value p value Body Image 7.6 <.5 Color concept 8.5 <.5 Size 6.4 <.5 Spatial Orientation 8.6 <.5 Dressing 5.68 <.5 Size Concept Table : 4 shows the significant improvement in all the areas. 4 7 IJOT : Vol. XXXIII : No. 7 Aug. - Nov.
Fig - 4 Spatial Orientation 4 7 concrete operational stage (7-yr) when the child is able to recognize relationship between objects. So in this study attempt has been made to train the child in cognitive skill which may help to acquire self help skills. Four cognitive skills and one self-help skill, dressing, had been selected for the study as acquisition of dressing skill is related to the child's present level of cognitive development. A pre therapy and post therapy asessment was done. table - and table- shows the scores. The data were statistically analyzed by paired t-test and determining the correlation coefficient to show the significant correlation. Fig - 5 Dressing Skill Seguin in his approach to educate mentally retarded, otherwise known as physiological approach (Sheerenberger, 98) developed a curriculum extending from developing basic self care skill to vocational education assuming a direct relationship between the senses and cognition. DISCUSSION The fundamental purpose of this study was to enable the subject to learn various ways of coping with his deficiencies so that there will not be a permanent block to a more normal functioning. The group selected for study was 5 moderately mentally retarded children of age group 5-8 years. At this age a child learns self help skills. Moderately retarded children were selected as they are considered to be trainable and can learn to care for their daily needs (Fred Biasini, Lisa Grupe, Lisa Hoffman, Norman Bray). According to the Piaget's four stages of cognitive development, -7 ys of age is considered to be the Preoperational stage when the child use language and mental imagery. Words, images and objects are used to represent other object. The child does not yet understand certain operation or rules for transferring information from one situation to another. In this stage the child also learns to classify objects by color shape and size. The next stage is After the statistical analysis.5 significance at 4 degree of freedom (Table-4) has been observed for all cognitive and dressing skill. This result indicates that the therapy was effective. In a previous study by Belmernt (978) generalization of skills has been characterized as a means of teaching the skill. Generalization enables the child to aply the effect of a trained skill to DRESSING other activities SKILL that differs from the therapeutic activity. The analysis also shows the improvement Pre in Therapy body image, size concept, color concept are significantly Post correlated Therapy at degree of freedom (Table-) with the improvement in dressing skill. But the same was not found in spatial orientation. 5 7 9 5 This reflects poor generalization of this skill. At the same time improvement in spatial orientation is found to be significant i.e..5 (table-). This suggests that maintenance of the skill was good where as generalization was poor. The child was not able to apply the skill effectively for dressing. The graphs (Fig. -5) show that the child who had scored less in cognitive areas during pre therapy assessment, scored less in dressing skill in the post therapy assessment. As suggested by Douglas and Peters (979), normal functioning can be attributed to an individual's ability to utilize the prior knowledge to guide the cognition of present events. Current level of functioning influences the progress. This statistical analysis reflects the importance of cognitive skill training for self help skill training for self help skill. Along with acquisition maintenance and generalization of skills are equally important. IJOT : Vol. XXXIII : No. 8 Aug. - Nov.
Limitation Of The Study : The present study was done on a small population for a period of five months./ further research on a large population for a longer period may show a more significant result. similarly comparative study on all the category of mentally retarded as well as on other areas of self help skills may explore the other dimension of mental retardation and aid in rehabilitation. CONCLUSION The findings of the study are consistent with the assumption. This suggests that Mentally Retarded children are capable of learning through efficient therapy programme to a far greater extent. REFERENCES. Berrios E. German: The history of mental symptoms, Descriptive Psychotherapy in the nineteenth century.. Biasini Fred, Grupe Lisa, Huffman Lisa, Bray W. Norman, Mental Retardation: A Symptom and Syndrome.. Craft Michael : Tredlog's Mental Retardation, 974, Twelth Edition. 4. Creek Jennifer: Occupational Therapy and Mental Health, Second Edition. 5. Freedman. Friedhoff, Kolb, Lourie, Nemiah: Year Book of Psychiatry and Applied Mental Health, 98: 77-84. 6. Freedman, Friedhoff, Kolb, Lourie, Nemiah: Year Book of Psychiatry and Applied Mental Health, 98 : 77-84. 7. Freedman, Friedhoff, Kolb, Lourie, Nemiah: Year Book of Psychiatry and Applied Mental Health, 98 : 77-84. 8. Freedman, Friedhoff, Kolb, Lourie, Nemiah: Year Book of Psychiatry and Applied Mental Health, 98 : 8-9. 9. Freedman, Friedhoff, Kolb, Lourie, Nemiah: Year Book of Psychiatry and Applied Mental Health, 984 : 8-88.. Hansen A. Ruth, Atchinson Ben: Conditions in Occupational Therapy, Effects on Occupational Performance, Second Edition.. Hosking Guilyn, Murphy Glynis: Prevention of Mental Handicap, A world View, 987.. Kamat N.B. : Mental retardation-a Multidisciplinary Approach, The elevonth.... Kirby R. John: Cognitive Strategies and Educational Performance, 984. 4. Leland Henry, Smith E. Daniel: Mental Retardation, Present and Future Perspective. 5. Pratt Pat Nuse, Allen Anne Stevens: Occupationl Therapy for Children, Second Edition. 6. Willson Moya: Occupational Therapy in Short Term Psychiatry, Second Edition. IJOT : Vol. XXXIII : No. 9 Aug. - Nov.