Ludwig van Beethoven

Who is this person?

Ludwig van Beethoven was a German composer and pianist born in 1770. He is one of the most influential musicians in history, bridging the Classical and Romantic eras in Western music.

What are their major accomplishments?

Beethoven composed nine symphonies, 32 piano sonatas, and several concertos and string quartets. His Symphony No. 9, featuring the “Ode to Joy,” remains one of the most celebrated works ever written.

What are they known for in the Deaf community?

Beethoven is admired in the Deaf community for continuing to compose and perform music even after losing his hearing. He proved that deafness does not limit artistic or creative potential.

What are important moments in time for this person?

Important milestones include his first public performance at age seven, the composition of his Third Symphony (“Eroica”), and his later works written while completely deaf, such as Symphony No. 9 and the late string quartets.

How did this person become deaf?

Beethoven began losing his hearing in his late twenties due to a suspected illness or lead poisoning. By his mid-forties, he was almost completely deaf, yet continued composing masterpieces.

What challenges have they faced?

Beethoven faced severe hearing loss, loneliness, and depression. He struggled with social isolation and frustration but used his emotions as fuel to create some of the most moving music ever written.

What contributions did they make to society?

Beethoven revolutionized classical music by expanding its emotional depth and complexity. His compositions inspired generations of musicians and symbolized perseverance through adversity, influencing art, culture, and human expression worldwide.

What does their background include?

Beethoven was born in Bonn, Germany, to a musical family. His father, a court musician, recognized his talent early and trained him strictly, leading Beethoven to study music in Vienna under Joseph Haydn.

What is their family life like?

Beethoven never married and had a strained relationship with his family. He helped raise his nephew Karl but faced constant legal and emotional battles over guardianship and personal relationships.

What does this Deaf person think about Deaf rights and equality today?

Though Beethoven lived centuries before Deaf rights movements, his story continues to inspire equality and inclusion. His resilience demonstrates that Deaf individuals can excel and contribute profoundly to society.

 

Tube Feeding

Feeding Routes

Food travels from the mouth through the pharynx, esophagus, and stomach, then into the small intestine. This process involves peristaltic movement and digestion, enabling nutrient absorption in the intestines.

Most Common Forms of Tube Feeding

NG (nasogastric) tubes go through the nose to the stomach for short-term feeding. G-tubes are inserted through the abdomen. Gastrostomy buttons sit at skin level for long-term access.

Types of Tube-Feeding Formulas

Formulas vary by dietary need: lactose-free (e.g., Ensure), milk-based, elemental for GI issues, or modular (e.g., protein-only). A physician selects the formula based on diagnosis and digestion ability.

Equipment and Adaptive Equipment for Performing Tube Feeding

Equipment includes feeding pumps, PVC or silicone tubes, and gastrostomy buttons like Bard or MIC-KEY. Devices vary by flexibility, shape, and features like anti-leak valves or decompression options.

Instructional Strategies and Modifications for Tube Feeding

Students should be taught to participate in tube feeding steps where possible. Procedures are broken into teachable tasks and adapted based on ability, using prompts, AAC devices, or task analysis.

Tube Feeding Task Analysis (Steps)

Feeding steps include handwashing, preparing formula and equipment, attaching the syringe, pouring formula, and monitoring flow. Each step can be individually taught and tracked to promote safe, independent feeding.

 Time-Limited Steps and Caution Steps

Some steps must be done quickly (e.g., clamping the tube) to prevent harm. Caution steps pose injury risks and may require physical prompts, modeling, or shadowing depending on student ability.

Aspiration

Aspiration occurs when formula enters the lungs, causing respiratory symptoms and risk of pneumonia. Proper tube placement, positioning, and monitoring signs like coughing or rapid breathing are crucial to prevent it.

Tube Displacement

If a gastrostomy tube/button is dislodged, quick action is needed. The tube should be covered, kept clean, and given to a designated adult. Proper taping prevents accidental pulling or snagging.

 Nausea, Vomiting, and Cramping

These symptoms may result from feeding too quickly, air in the tube, or poor digestion. Feeding should be stopped and adjusted. Proper technique and following IHPs help prevent these issues.

Diarrhea

Diarrhea may result from rapid feeding, formula issues, or bacterial contamination. It’s important not to stop feeding without guidance. Parents should be informed, and proper hygiene must be maintained

Site Infection

Infections can occur at gastrostomy sites, especially with prolonged use. Redness, drainage, or odor should be reported. Proper hygiene, drying, and medication are key to prevention and treatment.

 Leaking of Stomach Contents

Leaks may result from poor clamping or faulty buttons. Check the clamp, cap, and anti-reflux valve. If leaking continues, tape the tube and notify parents or physician for further action.

Clogged Tube

Clogs are caused by formula buildup, medications or pills. Regular flushing, proper prep, and avoiding incompatible substances help prevent clogs. Cleaning and monitoring are critical during and after feeding.

Management Issues for Tube Feeding

IHPs and IEPs must include clear feeding steps, emergency plans, and individualized goals. Instructions cover everything from formula prep to cleaning. Daily monitoring and documentation ensure consistency and safety.

Moving to Feeding

Transitioning to oral feeding is gradual and based on physician guidance. Students progress through textures, starting with liquids. Food presentation, stimulation and sensory comfort are crucial for successful oral intake.

Eating and Feeding techniques

Oral Motor Competency

Oral motor competency involves coordination of lip, jaw, tongue, and swallowing movements. Difficulties arise from abnormal reflexes or motor delays. Reflexes like biting or rooting can disrupt feeding, requiring specific strategies like avoiding touching sensitive areas.

Positive Practice

Developing mature feeding skills requires repeated, intentional practice of movements until they become automatic. Students must perform these refined skills consistently for successful eating. The more practice they get, the quicker they learn.

Environmental Factors

A calm, distraction-free setting supports better eating. Minimize noise and smells; avoid feeding near bathrooms or trash. Use bright utensils or high-contrast placements to aid visual attention. Ensure the student is well-positioned and stable.

Positioning and Motor Control

Proper positioning is crucial for feeding success. It affects comfort, motor control, and swallowing safety. Each student requires individualized support based on posture, tone, and alertness. Stability and visual access must also be considered before implementing feeding interventions.

Spasticity

Students with cerebral palsy may have muscle spasticity, causing head extension and unsafe swallowing. Tilting the head forward (5–15 degrees) helps prevent aspiration. Shoulder alignment is key; rolled towels or adapted wheelchairs may correct posture. Proper positioning supports better swallowing.

Severe Extensor Thrusting

This condition involves extreme body extension—arched back, tight arms, and retracted shoulders—often worsening feeding challenges. Students may experience unsafe swallowing and tongue or lip retraction.

Hypotonic (Low) Muscle Tone

Low muscle tone affects head and trunk control, causing poor posture and food pooling. Support with headrests or tray height adjustments helps maintain alignment and reduce aspiration risk during feeding

Athetoid Movements

Involuntary movements in athetoid cerebral palsy interfere with feeding. Stabilizing head and limbs using straps, dowels, or weighted tools improves control. Supporting head midline enhances safe and independent eating.

Primitive Reflexes

Persistent infant reflexes (ATNR, STNR) affect posture and feeding. Head turning triggers asymmetrical movements; chin tucking causes leg and arm shifts. Positioning and head support’s help minimize reflex activation.

Oral Tactile Defensiveness and Lack of Tactile Response

Some students overreact to oral input, rejecting food; others underreact and can’t feel food in their mouths. Desensitization or sensory programs help improve oral awareness and feeding comfort.

Food Consistency for Tongue Thrust

Thickened or altered food textures reduce exaggerated tongue movements. Smoother textures and slower flow support mature swallowing, jaw movement, and safer, more controlled feeding for students with tongue thrust.

Jaw Support for Tongue Thrust

Jaw support helps stabilize tongue position and reduce thrusting. Applying gentle pressure under the chin supports alignment. Not suitable if thrusting relates to breathing difficulties or respiratory issues.

Tongue Pressure for Tongue Thrust

Pressing down on the tongue with a spoon for 2–3 seconds helps reduce thrust. Placing food on the front third of the tongue assists with control and safe removal.

Vibratory Input for Tongue Thrust

Vibration on the tongue can reduce thrust. With infants, a finger is used; with students, a spoon delivers gentle, rhythmic stimulation. Helps improve tongue awareness and reduce unwanted movement.

Tonic Bite and Unstained Bite Reflexes

Tonic bite causes tightly clenched jaws triggered by stimulation. Unsustained bite involves hesitation when biting. Both hinder functional biting. Strategies include environmental adjustments, tactile support, and feeding techniques to build control.

Preparing the Feeding Environment for Tonic Bite

Proper seating and a calm, low-stimulation environment help prevent tonic bite. Poor posture and overstimulation increase tension and oral defensiveness, making the reflex more likely. Positioning is key to regulation.

Tactile Input for Tonic Bite

Firm, predictable tactile input to face and mouth can reduce hypersensitivity. Avoid light or tickling touches. Calm preparation helps build tolerance. Therapists can guide caregivers on safe, appropriate tactile strategies.

Feeding the Student with Tonic Bite

Reduce bite reflex frequency by creating a predictable feeding rhythm. Present cups or spoons to the lips, not teeth. Use soft-coated tools, jaw support, and cheek delivery if needed.

Releasing Tonic Bite on a Utensil

If a utensil is clenched, don’t pull. Use calm, firm pressure and check head alignment. Facial massage or jaw pressure may release tension. Gentle manipulation can open the bite safely.

Allergies

Food allergies can cause intestinal, respiratory, or skin reactions—sometimes delayed. Elimination diets help identify triggers. Students may react to new foods or previously safe ones, requiring close monitoring and planning.

Management Issues for Feeding and Eating

Individualized Health Plans (IHPs) and IEPs outline feeding needs, dietary restrictions, and assistive strategies. Tracking prompts and progress ensures safe, consistent support—especially for students with allergies, motor issues, or emergencies.

Assistive and instructional strategies for communication

Accessing Communication Boards and Devices

Students need proper positioning to access communication aids effectively. Devices like slant boards, lap trays, or adjustable desks may be used. Pointing tools such as head pointers, mouth sticks, or light beams support symbol selection. Access depends on students’ physical, sensory, and cognitive skills, with occupational therapists assisting setup.

Direct Select

Direct select involves students pointing or touching symbols directly. It’s the fastest and simplest method, preferred for those with fine and gross motor abilities. This system avoids intermediate steps, making it efficient for communication.

Scanning

Scanning is an indirect access method where students use switches to choose symbols. Types include automatic, inverse, step, and direct scanning, tailored to cognitive and physical abilities. Choices may be highlighted visually or auditorily, with patterns like linear or circular arrangements.

Encoding

Encoding uses codes to represent messages by combining letters, numbers, symbols, or colors. Systems like Morse code or abbreviation expansion (e.g., “EMD” = “I want McDonald’s”) allow faster communication. This requires consistent motor or cognitive control and is suited for students with reliable skillsets.

Vocabulary Selection

Vocabulary for physical and health needs depends on the student’s cognitive and physical abilities. Selection should be individualized rather than from standard lists, making communication more efficient. Words should help students express needs or instruct others in procedures, using a structured step-by-step process.

Vocabulary to Express Health and Physical Needs

This includes both general words (“hurt,” “sick”) and more specific terms (“headache,” “nausea”). Tools like pain gauges or body charts help students indicate severity and location of pain. Additional vocabulary supports problem-solving actions such as requesting medication or calling a parent.

Vocabulary for Performing Health Care Procedures

Students with physical disabilities may not perform tasks themselves but can direct others. Vocabulary should include names of supplies, steps of procedures, and instructions. This gives students independence and control, even when relying on trained or less-trained personnel for assistance.

Instructional Strategies for AAC (Augmentative and Alternative Communication)

Students requiring AAC must be systematically taught to use it in daily routines. Communication opportunities should be frequent and embedded in activities like snack time or requesting mobility. Consistent responses to all attempts are essential, ensuring students learn to use devices effectively across varied settings.

Instructional strategies handout

Antecedent Prompts

Antecedents are cues or instructions used to initiate behavior. When natural cues aren’t enough, teachers use prompts to guide correct responses. Prompts should highlight natural cues, be as minimal as possible, and be faded quickly to avoid dependence. Overuse or strong prompts can hinder independence.

Expanded and Relevant Feature Prompts

Expanded prompts add extra details to natural cues (e.g., tracing dots to write a name), while relevant feature prompts highlight essential task features, often with color coding. These support correct responses but must gradually fade so the natural cues eventually stand alone.

Proximity Prompts

Proximity prompts involve altering the placement of materials to guide student responses. For example, placing the correct utensil closer during trials helps highlight it for selection. Over time, the distance between materials is reduced until they are presented equally, promoting independent, accurate choices.

Associative Prompts & Modeling

Associative prompts pair abstract concepts with concrete examples, like flashcards showing the word fork with a picture of a fork. Over time, prompts are faded to encourage independence. Modeling involves a teacher demonstrating a behavior for students to imitate (e.g., brushing teeth). For effectiveness, teachers must gain attention, provide clear demonstrations, and use simple cues.

Match-to-Sample & Self-Operated Prompts

Match-to-sample prompts provide an example item for students to follow, similar to modeling but object-based (e.g., showing a sample completed task). Self-operated picture or auditory prompts guide students through tasks, offering ongoing support, particularly for multistep activities or students with cognitive challenges.

Learning Strategies

Learning strategies focus on how students learn rather than specific content. They are especially useful for students with mild or no impairments. These strategies include describing, modeling, rehearsal, and practice. They often use mnemonics (e.g., ESP—Equipment, Steps, Problems) or rhythmic structures (songs, raps) to support memory, note-taking, health, and physical education.

Response Prompts

Prompts help students perform behaviors that are absent or incomplete. They guide motor responses, prevent errors, and reinforce correct performance. Five types include:

• Full physical prompt: teacher fully assists.

• Partial physical prompt: minimal assistance or direction.

• Model prompt: teacher demonstrates for imitation.

• Gesture prompt: teacher signals nonverbally.

• Verbal prompt: teacher gives spoken instructions.

Systematic Use of Response Prompts

Prompts should be used systematically, either as a single strategy (time delay) or multiple strategies (maximum prompts, least prompts, graduated guidance).

• Time delay: teacher gives an instruction, waits for student response, then prompts if needed.

• Maximum prompts: start with full assistance and fade gradually.

• Least prompts: begin with minimal help and increase if necessary.

System of Maximum Prompts

This method begins with the most assistance (e.g., full physical support), then systematically reduces help as the student gains independence. The teacher provides errorless practice, testing reduced levels of prompts until the student can perform independently. The goal is to fade teacher involvement while increasing student mastery.

Demonstration-guided practice-independent practice model

This model is often used with students with mild to no cognitive impairments. It involves three stages:

1. Demonstration – the teacher explains and models the skill.

2. Guided Practice – students practice with teacher support, prompts, and feedback.

3. Independent Practice – students perform skills independently, with minimal guidance but continued feedback when needed.


It gradually shifts responsibility from teacher to student, allowing skills to be learned, generalized, and practiced until mastery.

Three step process

Ecological inventory

An ecological inventory is a process teachers use to identify functional or specialized skills students need to participate in school, home, or community activities. It focuses on real-life tasks rather than isolated developmental milestones, taking a top-down approach to curriculum.

It involves a five-step sequence:

1. Listing current and future student environments.

2. Identifying relevant sub-environments.

3. Listing priority activities in each sub-environment.

4. Identifying skills needed for those activities.

5. Prioritizing activities/skills for the student’s Individualized Education Program (IEP).

Listing Current and Future Environments

Teachers identify a student’s present and future school, home, and community environments through interviews. These include classrooms, cafeterias, gyms, and community places like grocery stores, malls, and medical services.

Identifying Relevant Sub Environments

Sub environments are specific areas where different activities occur, such as kitchens, bathrooms, or grocery store sections. Recognizing these allows teachers to plan functional skills relevant to each unique setting.

Listing Priority Activities

Teachers identify functional activities in sub environments, like ordering food in restaurants or navigating grocery stores. Activities are broken down into steps, ensuring students learn essential participation skills within environments.

Identifying Priority Skills

For each activity, teachers identify necessary motor, communication, social, and academic skills. For example, tube feeding requires equipment preparation, giving formula, and cleaning tools—focusing on practical life skills development.

Discrepancy Analysis

Discrepancy analysis identifies gaps between what a student can currently do and what is required. It involves observing performance, noting errors, and determining skills needing direct teaching, adaptation, or alternative strategies. This structured process highlights exact instructional needs for skill mastery.

Performing a Task Analysis

Task analysis breaks activities into small, measurable steps to support learning. Teachers or peers may model each step while recording functional or motor actions. This method allows clear observation of 

student ability, highlighting specific skills to target for teaching or adaptation.

Observing and score performance

Teachers observe whether students can perform task steps independently, with verbal guidance, or with physical assistance. The goal is to assess understanding, motor ability, and independence. Teachers record results, noting full independence, partial assistance, or guided performance, ensuring accurate tracking of student capabilities for instructional planning.

Recording Student Errors and Doing a Performance Discrepancy

When errors occur, teachers record them, analyzing causes such as cognitive, physical, sensory, motivational, or communication issues. This process helps identify why a step wasn’t completed, guiding whether further instruction, adaptations, or alternate strategies are necessary for student success in performing required skills.

Providing Instruction, Adaptations, or Alternate Performance Strategies

Teams decide whether to reteach as modeled, adapt tasks, or develop alternative strategies. Adaptations should only be used if essential, and instruction should promote independence. When adaptations are ineffective, alternative strategies (e.g., technology or communication devices) may be introduced, ensuring students achieve the same functional outcomes despite impairments.

Strategies, Problems and Management

Instructional strategies

Students using positioning equipment are taught communication signals, schedules and movement preparation to reduce resistance. They may practice independent mobility, assist with adjustments and signal discomfort. Instruction encourages participation, relaxation, and safety checks. On leaving equipment, functional movements and skin inspections are emphasized to support independence and prevent complications.

Handling and positioning problems and emergencies

This section emphasizes safe handling and positioning of students. It highlights that positioning should never cause pain or be forced. Adults must watch for signs of distress, such as crying or grimacing and students should be taught to indicate discomfort. If pain arises, repositioning or removal from equipment is necessary. Regular checks for redness or injury should be performed, with reports and appropriate actions taken. Therapists should guide responses even if no visible injury is present.

Management issues for handling and positioning

IHPs (individualised health plan) and IEPs outline handling methods, equipment use and emergency precautions. They include therapy needs, risks, and objectives to support student safety, independence, and achievement of educational goals.

Tracking implementation

A student schedule organizes handling and positioning alongside academic activities, ensuring consistency. For example, during reading, a student might spend 20 minutes prone over a wedge to improve engagement. Data sheets track type, duration and goals of positioning to monitor progress, safety, and effectiveness. Documentation also helps evaluate how positioning aligns with educational goals, such as comprehension or motor skills, and ensures planned use of equipment. Regular data collection ensures students benefit functionally and educationally from positioning strategies, while maintaining accountability for both staff and student progress.