1984 . . . Before the MOVE Program . . . A Cold Hard Look at the Blair Learning Center in Bakersfield, California

Communication Skills - Other than smiling or crying, the majority of the students had no expressive language. Speech therapy which included augmentative and alternative language training produced little or no change in communication skills. The majority of the students appeared to have far better receptive language than expressive language, i.e., many responded by looking at the speaker to their names and words like Mama, bus, eat and drink. A physical assessment was made of the students to determine the most logical form of alternative communication. The students were then introduced to a program developed at the Blair Learning Center to teach students symbolic representation. As an example of the program, the students were taught to touch or look at a paper cup filled with their favorite liquid to indicate the desire for a drink. When the student reached a proficiency level, an empty paper cup was cut down until only the circular bottom remained. It contained a picture of a cup, and the student therefore was using symbolism to indicated the desire for a drink. The same method was used for the category of food which began with a real spoon with a favorite food and ended with a small picture of a spoon. Using the same technique, varieties of food and drink were offered. The shocking result of the program was that the students who had any sort of mobility skills (crawling, rolling, squirming) were able to succeed in the program and make meaningful choices. Those students who lacked any sort of mobility were unable to make meaningful choices. At that time, we did not know whether they were cognitively unable to differentiate or whether they did not understand that they had options.

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

Toileting Skills - Students under the age of 7 were routinely placed on toilets. Toilet training efforts were reduced or completely dismissed as students grew older, became heavier, or developed deformities which made sitting difficult. When possible, students had diapers changed on changing tables. As they grew too large to be lifted safely, they were changed on mats on the floor or in bean bags. Large students with skeletal deformities took an average of 20 minutes of adult assistance for a single diaper change (2 adults X 10 minutes). A class of 10 large students with motor delays required three hours and 20 minutes of adult attendance for custodial care a minimum of twice a day.

Motor Skills - Therapy services were provided by the Kern County California Children's Services (KCCCS) for those students who had medically eligible diagnoses and were deemed capable of making measurable progress in developmental activities. The vast majority of the therapy services were delivered in the "consultant" mode. That is, the therapist would discuss the child's needs with the classroom teacher and instruct the teacher in positioning and activities that would benefit the person. The classroom teacher would then try to fit those activities into the child's classroom day. A number of articles published by E.E. Bleck, R.K. Beals and others reported that children over the age of 7 who had not gained independent motor skills by 7 were unlikely to ever do so using traditional developmental programs based on the sequential skill acquisition of infants. The students at the Blair Learning Center supported these findings.

Home Life - Students who could be lifted and carried easily were taken out into the community with the rest of the family. As the students grew larger and more difficult to lift and transport, they stayed at home more often. The majority of non-ambulatory teenage students went into the community only to attend school (via wheelchair bus) and for medical appointments. When the family went out, one family member would stay at home with the non-ambulatory person or occasionally a sitter was hired. Sometimes, the non-ambulatory person was left unattended for short periods of time. Bathing was considered the most difficult task to be performed in the home. Many students were bathed once a week in a bathtub or shower and had sponge baths in bed the rest of the time. Usually the student ate at different times than the rest of the family and often ate in a reclining or semi-reclining position either in the living room or bedroom. Diapers were often changed in the same environments because moving the student was so difficult. The mother often slept with the non-ambulatory student because of the periodic need for repositioning or other attention during the night. Home environments as well as community environments decreased in direct proportion to the severity of physical disabilities and the size of the students.

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

After visiting a number of other schools with students similar to ours, we concluded that we were not alone in our inabilities to provide our students with a meaningful education. In every instance the time requirements for custodial duties were so overwhelming that little time was left for education. Parents, teachers and aides were physically exhausted. The only sensible solution seemed to combine education with the custodial duties that demanded so much time.

This was the beginning of the selection process of the tasks to be taught and the eventual emergence of the MOVE Curriculum for children.