[eGCI Team]

COOKING WITH DISABILITIES PART ONE: COOKING AS A PERSON WITH DISABILITIES Including Dietary Restrictions by Judith Benton PART TWO: COOKING FOR/WITH A PERSON WITH DISABILITIES by Susan Fahning & Jenna Umansky PART THREE: SENSORY ISSUES, NAUSEA & FOOD ISSUES WHILE TAKING MEDICATION by Judith Benton, Susan Fahning & Jenna Umansky PART ONE: CONTENTS INTRODUCTION BACKGROUND OBJECTIVES SAFETY CUTTING EQUIPMENT MISE EN PLACE WHERE TO COOK? DIETARY RESTRICTIONS SODIUM FAT/CHOLESTEROL RECIPES RESOURCES GLOSSARY INTRODUCTION We three, Lovebenton0, Snowangel, and Specialteach, have had our lives touched by disabilities. Lovebenton0 is a person living with deafness and a vestibular disability that presents as constant imbalance, vertigo attacks, coordination problems, and vision impairments. Snowangel is the mother of a child with mental and physical disabilities as the result of Angelman's Syndrome. Specialteach, who was diagnosed with a chronic illness in the 1990s, is a teacher guiding students with various disabilities. We have learned to adapt. The world we exist in is full of challenges many do not even consider. Can I hear the timer go off? Can I feed a family with good food and meet the requirements of a special needs child at the same time? Can I put together a meal without turning on the oven or using a knife? Our worlds often revolve around safety, texture, and medicinal issues. Life can still revolve around great food. During this course we hope to explain challenges faced by people who live in the world of disabilities and how we overcome them. Through our personal and professional experiences, we hope to share how having a disability or living with someone who does, can enhance your life in unexpected ways. If nothing else we have learned how to be creative and safe in the kitchen. We hope you can take this knowledge and adapt it to fit your own needs. Disabilities we will be targeting include hearing impairment and deafness, mental retardation focus (which will cover other mental and physical disabilities such as caring for persons in wheelchairs, Alzheimer's patients, people with mastication problems, as well as grip and coordination problems), vestibular disorders (such as balance and coordination problems, and related vision impairments). We will also target some solutions and suggestions for dealing with problems we encounter in food consumption such as nausea. We are going to touch on some dietary restrictions such as suggestions for low-sodium and low-fat/cholesterol. We will also cover how to add good fat and nutritional elements for difficult appetites,  texture and other sensory-related issues, difficulty eating while on medication, and one's abilities to eat. We are looking forward to a Q&A on this course, to encourage open discussion and questions from the forum. More extensive individualized bios for the specific instructor will accompany the topics for each course. Instructor Judith Benton aka "Lovebenton0" Judith Benton (aka "Lovebenton0") has been cooking since she was nine years old. Her stepfather, a gourmet cook himself, took her into the kitchen and showed her the way around escargot nestled in their little shells in garlic butter, salmon smoked to a sublime flake and artichokes, aspic, Chinese vegetables, and curry. She was in a little girl's heaven. But the heart and soul of cooking came to her as she grew her own herbs, started making bread, and creating new delights for her own family. Through many changes and challenges, she never stopped cooking -- whether that was while camping for weeks at a time on a geological survey, or on an archaeological site, catering jobs for movies, or cooking for over fifty Girl Scouts, a school carnival, or for just family and friends, cooking has remained a joy to be shared. Working as an artist in her own business for 15 years, Judith returned to school in 1992 to finish what she had started in 1970, before starting a family. She earned a BA in Anthropology in 1996 from Southwest Texas State University while teaching Geology lab courses. She then moved on to the University of Alabama and earned an MA in Anthropology, specializing in the iconography (sacred symbols) of pre-contact Native Americans in the Southeast. For her thesis, she lived near her research area, the Moundville site, focusing on the iconography of engraved ceramics created there during the 13th to 16th century. In the fall of 1997, during her second year in graduate school, she was suddenly struck deaf in the right ear. Completing her course work and research, she obtained permission to return to Texas to finish writing her thesis. While working on research for the City of Austin she completed the thesis; graduating in the fall of 1998. The PhD fellowship for Anthropology at the University of Oklahoma was waiting for her to arrive the next fall. Early in the summer of 1998 Judith began to lose hearing in the left ear and to experience severe attacks of vertigo. Diagnosed later that summer with bilateral Meniere's disease -- a hearing and vestibular disease of the inner ear -- she was unable to maintain a level of required functionality and was forced to forfeit the PhD program. Fitted with a  cochlear implant (CI) in 2001, she can only say that to hear again is "Amazing!" However, it is not the natural ear; many sounds and ranges do not carry. Continuing to work for the City, her condition was worsening and she has been on total disability since October of 2002. Judith´s balance system and natural hearing may only be a memory now, but she is still cooking with joy; hoping some of the methods she has learned by adapting to her situation may help you to adapt to yours.    BACKGROUND Cooking with a disability is a recent development in my life, compared to the many years I cooked without these new challenges. When I quite suddenly became deaf in my right ear during the fall of 1997, a hearing loss was the last medical problem that I would have listed as a concern. That sudden loss changed my life. I had lost stereophonic and directional hearing capabilities. I remember that the first question I had for the audiologist when she told me that I was stone deaf on the right without a chance that hearing could be recovered either naturally or with a hearing aid, was, "So I'll never hear in stereo again?" I had not had time to consider the many ways this would affect my life. I had no directional hearing, could not hear someone speaking to me from that side, and my head felt "numbed" to the world. But I was fitted with a crossover hearing aid, which gathers sound on the deaf side and feeds it into the hearing ear. Then everything seemed to come from the left. I had to look around to tell where any sound had originated; people, music, elevators and traffic noises. Sirens in traffic were suddenly terrifying. I was back to "look both ways" for every activity in my life. Within several months, when I thought I was beginning to get a grip on the situation, I began to lose the hearing in the left ear and needed a new hearing aid. Now I had a crossover hearing aid that also amplified sound for the ailing good ear. There was nothing to prepare me for the next level of damage to my inner ears and the vertigo attacks. Without warning, the world was spinning, I was on the floor, and violently ill for hours to days at a time. Finally, after a series of tests, attempts at treatment, and a weeklong stay in the hospital, I was diagnosed with bilateral Meniere's disease. Although I had been dealing with epilepsy since 1984, and in the beginning had learned some safety lessons the hard way, that condition had been controlled by medication. With this new set of challenges, I was now making major changes in my kitchen and dining behavior by adjusting to the way I could physically handle the tasks of cooking and my dietary requirements. As my condition worsened I adapted more methods and equipment to the ever-changing challenges presented by my disabilities. Dietary restrictions had become a reality in my life. I must adhere to a low-sodium diet due to the Meniere's disease while simultaneously maintaining a low-fat and low-cholesterol diet due to an unexpectedly high cholesterol count. Other medical problems require that I keep my iron intake low and calcium intake high, so I subsequently shift and substitute ingredients every day. Despite the vestibular disorder and deafness resulting from the Meniere's disease (with attendant vision and constant imbalance/mobility problems), my continuing joy in cooking prompted me to answer the call when eGCI asked for instuctors for a class on Cooking with Disabilities. I could not have asked for two finer co-instructors than the ladies I have delighted in working with on this course. We each bring our own perspective, but much is interrelated, and we hope that you will have the opportunity to take part in each of our lessons. OBJECTIVES The objective of this three-part course is to present suggestions and solutions to challenges encountered when cooking as a person with disabilities, cooking for persons with disabilities, and cooking with persons with disabilities. Lessons will involve the issues of safety, methods, and equipment. Recipes, and their links, will accompany the lessons, as well as links to sites we have found helpful for understanding focus disabilities. We will make use of photographs for illustration, links to products available, and home solutions that help ease the challenges concerned. During Part I, Cooking as a Person with Disabilities, the student will learn methods of choosing, preparing, and cooking food through examples and by following recipes presented that accentuate methods used when vision, hearing, mobility, balance, and grip may be a challenge in the kitchen. In the additional section on Dietary Restrictions, the student will be given suggestions for coping with those problems. By the end of the lesson the student will have learned new methods; suggestions for equipment use, the adaptation of equipment and the kitchen, for dealing with particular challenges of cooking with a disability. This is only a beginning. We hope to explore more methods and equipment as students feel prompted to ask us questions and openly discuss needs in the Q&A. SAFETY Safety will be a major subject in this lesson on cooking as a person with disabilities. Together we will also explore methods to make the cooking we want to do easier and less stressful so we can continue cooking with joy. Of course these two objectives will often cover the same material. I will also touch on some basic food restrictions and problems associated with many different disabilities; sodium, fat and cholesterol, and the addition of healthy fats for the difficult appetite. Part III will focus on the topics of Nausea, Sensory Issues, and Food Issues While Taking Medications. A more determined meal planning and cooking strategy, are often necessary when cooking, and eating, are daily challenges. A quick comment here on safety and use of mobility equipment: I have had to use a walker for extended periods of time and it is actually not a bad situation in a normal kitchen. Be aware not to rely on the walker for stability and strength beyond its capabilities, it gives the person something to hold on to when reaching up or bending down. I do use a cane regularly as a walking and stability aid. It can also be useful in the kitchen, but often you probably just stash it at the end of the counter out of the way as I do, while using counters and cabinets for support. For many of us, the kitchen existed before we began living with our disabilities. You may need to take the time to remake the kitchen into a more useful work area. Consider what is safe and convenient for you. Everyone else will learn to adjust. Keep hot mitts and/or hot pads close at hand. Pull out the oven rack; do not reach into the oven. Always pull out the rack before getting food to place in the oven, or to rotate, or remove food. Burns are bad, and if one loses balance suddenly it may not be possible to know, or to move in, the direction to safety. Double handled pots allow you better control when moving food. Long handled ladles are good for serving to keep hands away from hot foods. Avoid storing anything you need to reach over a heat source. Do not hesitate to ask for help when you need it. Stop. Wait. This can be difficult to do; we may need help now doing things that never required assistance before. Accepting help is easier than accepting injury. I hope that the suggestions here will help to minimize those times you need assistance. CUTTING Let your food processor help you with tasks appropriate to its abilities. Manual food choppers are handy for smaller jobs, with less clean up. Keep your knives sharp; although that may sound scary, you are much less likely to cut yourself using a sharp blade than one that has become dulled. If you do cut yourself with a dull blade it is also likely the injury will tear the flesh causing more problems for treatment and healing. If possible, hold the food stable with a fork instead of your fingers. When that is difficult it can also be helpful to hold the food down with a plastic gripper flat under your hand, while staying at a distance from the cutting blade. If you will be using them in a cooked dish, steaming/parboiling whole vegetables just to the point of slight tenderness before cutting will ease the task. Cook potatoes whole, cool to easy handling temperature, and slip the peelings off before adding to recipes calling for peeled potatoes. Meats can be slightly browned or sauteed in whole pieces before cutting for easier handling. If your meat is frozen, it makes the job much easier if you allow it to become only half-thawed, and then cut into pieces required for your recipe. Enlist the aid of a butcher in your local grocery store or butcher shop. They often will be glad to precut meat, poultry, and fish for you for FREE into usable pieces for your recipe. This can greatly reduce the amount of butchering you have to do on your own. Kitchen shears are also helpful when using a knife is difficult. The food can be held in a deep bowl as you cut. There are products out there developed for those of us who do not have the grip and clamp capabilities needed for regular shears. Cooking.com is a useful site for shopping. Pizza cutters (the good old wheel type) work well as an alternative cutting tool for  many things such as slicing tortillas, quesadillas, sandwiches, and multi-use dough. They are also great for a chiffonade of herbs and leafy greens. I have used mine with great success for slicing onions. You can cut the onion into very thin slices by moving the wheel across the onion, a task I find difficult to accomplish now with a knife. If necessary, you can use your knife to cut the onion once so you have a flat side to place against the cutting board. This method is also very useful for other vegetables such as squashes and eggplants. Invest in a pizza wheel that is well-made with a larger handle for more control and easier grip. Cutting technique with a pizza wheel. The rocker style pizza cutters are also good for some of those tasks as well as cutting firmer vegetables, potatoes for fries, and vegetables for stir-fry. Knives with built up grips are also available for those of us with gripping/grasping difficulties. METHODS Adaptations   Position your food, dishes, and equipment at levels that are comfortable for you. Everyone else will get used it. Avoid storing anything you need to reach above a heat source. Using porcelain enameled metal, plastic, or stainless steel bowls for mixing and holding your ingredients reduces the chance of breakage and lessens stress. A gripper pad to set the bowls on during mixing aids stability. I am deaf; although the cochlear implant (CI) is amazing, not all tones register. If I cannot wear the CI, I am without functional hearing. At all times, I cannot hear well from any distance in the house beyond 15 feet, definitely not with any background noise (people talking, traffic, music, television, water running, etc.). I often need to rely on my watch for timing if I will be busy in another part of the house. If you are occupied with life beyond the kitchen while cooking, it is helpful to write down when you started your timing and when you need to return to kitchen for the next step. If I'm in the kitchen, or close by, within 15 feet, I can use the microwave timer because it has a high pitch beep; buzzers do not register. For some people the range may be just the opposite. They may need to use a different secondary timer. This is also true for many people with hearing aids and those with moderate to profound hearing loss.   Assistance devices are available for the hard of hearing (HOH) and deaf, i.e., light flash response alerts for timers and alarms, similar to the phone or doorbell alerts. There are also vibration alerts; I have even used my pager and my cell phone set on vibrate as timers. I am unable to distinguish when something starts to simmer, boil, or sizzle, unless I am right at the stove. This demands stricter attention. Although the "watched pot never boils," the unwatched pot can boil over. Make a place in your kitchen that is comfortable and safe for you, allowing you to spend the time closer to your cooking project that you need. Independent Living Aids is a good site for many cooking aids, including adjustable knives with guides and slicing guide for roasts, large vegetables, and bread, as well as timers, etc. This site is geared more for people with vision impairments and gripping/coordination difficulties. There are too many products to list for you here. If nothing else, the site can give you a good idea of the products, often quite inexpensive, that are available. I often have double vision, and oscillopsia (jumping vision). I have difficulty focusing, finding large print or viewing with magnification necessary even on good days. Printing out recipes or instructions in large type from my computer is a big help. Non skid rugs or pads to stand on at your work stations will help reduce leg and back stress from fatigue. EQUIPMENT Once the equipment used is no longer necessary, it is wise to remove it from your immediate work space to prevent accidents or the possibility it will be knocked over. Try to reserve a space close at hand to shift all the used equipment and ingredients. Cutting boards shaped with a spout on one end, and flexible cutting boards, are useful aids for reducing transfer spills. Even the disposable cutting sheets now available are useful as flexible cutting "boards." I have to read large print. The link to Independent Living Aids offers many products for people with vision impairments; some for deafness/HOH impairments, and motor skills impairments. Utensils    Double handled pots and pans are much easier to lift and to control while moving or transferring food. You may not be able to rush to get new cooking utensils, but when you do invest in new, look for double handles. Put them on your holiday, birthday, anniversary, Mother's Day, Father's Day, "just cause you love me day" list. I know many of us love those heavy utensils and cast iron skillets. I certainly do. But, you need to consider what you are capable of handling now. I have had a 4 quart cast iron dutch oven, with a hook-on lid that can also be used as a shallow skillet for about 15 years. I am so glad that both pieces have double handles. Cast iron Dutch oven with double handles. If you do not already have a crock pot/slow cooker and a pressure cooker, they are worth considering as new additions to your kitchen. The slow cooker is wonderful for those days that you do not have the energy to go through 10 steps to make a delicious and nutritious meal. The pressure cooker is more versatile than you may have imagined and is a life saver for those days that you just do not have the time or ability to spend a long period of your day cooking. They are also good for helping you quicken the steps in a usually long and possibly too tedious recipe that you want to make anyway. There is also the added benefit of one utensil to clean up. You can put them on your lists, too. MISE EN PLACE First gather all ingredients and tools from one location at a time, to your work space. A small cart with top shelf convenient for your height requirements is helpful. If you are in a wheelchair your lap can be a convenient shelf for moving most supplies. Next, prep everything in the beginning. I don't move or cut as quickly as I once did. This will help keep you on schedule through the steps of the recipe. You can always return meats, etc., to the refrigerator if it will be a long time before they are to be added. Then you can gather those ingredients at once, ready for the next step. Try to reserve a space close at hand to shift all the used equipment and ingredients for ease in clean up and return. This will also reduce the chances for spills and other hazards. WHERE? I am often able to stand at the counter, because I can lean on it for stability; a good alternative to the cane, which impedes my ability to use both hands. At times it is helpful, even necessary, to sit at the table with the bowl(s), colander(s), and the cutting board in front of me for food. You can then transfer all prepared ingredients to your cooking area, to set your mise en place. Again, a cart is helpful. Maybe some days, a bowl in the lap is as much as you feel like doing. Make use of your coffee table or kitchen/dining table for placing food to be prepped, and for food after prepped. You may find that the table becomes a better alternative than your lap. You can achieve more stability at the table, and have more room to work.    DIETARY RESTRICTION I have to balance being "too lean" with my particular dietary restrictions, which include low-fat, low-cholesterol, very minimal sodium and iron intake, no caffeine, but extra calcium. Absolutely NO alcohol intake, unless cooked. Recent studies have shown that there may be some alcoholic content remaining even after the alcohol is boiled, so if you must remain 100 percent alcohol-free I would advise caution in using alcohol in your recipes. I often use alcohol-free wine or beer in my recipes, but even those do contain a miniscule amount -- often as much as one-half percent per serving. I cannot say for a fact that the content is reduced to zero after cooking. When I post recipes for fat-free or low-fat, low-cholesterol, etc., it means I have worked out a recipe that is yummy and follows those restrictions. It is not hard and still quite satisfying, to eat within your restrictions once you learn to utilize some tricks and substitutions. I can splurge at times and allow myself that for special occasions, although seldom not more than once a month. I then have to be very, very careful for the next few days. I pay for it. Too much salt, too much fat, cholesterol way over my limits, I can become dizzed out, seeing double for days. Often I have a very rough week while being good! Because of that I sometimes just let the frustration fly away and eat something a bit bad for me; so often I can't eat at all. So tweak away, substitute that fat, or higher cholesterol ingredient, etc., based on your own dietary restrictions and needs. I will continue to post for my dietary restrictions. It is one of my personal challenges. I will often add the higher content food as an OR in the ingredient list. I trust you to know when you feel you can use full fat dairy and to salt to your taste, based on your own allowances. My physical activity is so far below what my body was used to for most of my life, due now to my medical condition (no more mountain climbing, rough out hiking, swimming, archaeological digs, and geological surveys in the midst of nowhere). I am lucky to be able to walk very far and most days climbing the steep stairs in my own house to the second floor is not possible. I no longer have the same caloric needs I once did. I can observe my restrictions and my caloric intake, with grains, rice, pasta, nutritious homemade breads, lots of veggies, fruits, soy products, and small servings of lean animal protein, fish, and seafood. Here is a fine web site for looking up the cholesterol, calories, fat content, sodium, and carbs of over 1,000 foods. Easy to use, it will help you get a good idea of basic counts per serving. Of course buying lean meat trimmed of fat, and de-skinning all poultry and fish, will reduce the fat and cholesterol count in your recipes. SODIUM I have to admit, I'm not a big salt person to begin with. I hardly use it to cook with and never add any extra at the table. But plenty of food out there is salty. I love olives and pickles as well as ketchup, mustards, and table salsas. I make my own Tabasco sauces with our peppers, and salsas with the fresh tomatoes, chilies, and herbs from our garden, so I am not immune to its temptations. And don't forget cheese! That dairy delight is high in sodium, besides the considerations some of us may have for low-fat and cholesterol restrictions. Most of us are cheese eaters and feel deprived if we cannot cook with it, or just eat some when we want it. So, how do you live and eat through all this? One very important point to remember while counting your sodium for the day is that it is important to divide your sodium intake as equally as possible between your meals. If you are allowed 1,500 mgs of sodium per day, and eat three meals a day, you can have 400 to 500 mgs per meal. If you want to snack between, try to pick fresh sodium-free foods such as fruits and vegetables or dried fruits. The sodium content is so low that you need not worry over a few milligrams slipping in there between meals, if you give yourself a little buffer. Most fresh fruits and vegetables have only 10 to 20 mgs sodium per serving.   Keeping low, low-sodium homemade stocks (chicken, beef, vegetable) on hand in the freezer to use in your recipes is beneficial. It is often much tastier than what you can buy off the shelf anyway. Watch the sodium count in any processed food. Tomatoes are the worst for sodium content of the canned vegetables (and juices) which we indulge in during the off season. Choose low-sodium or no salt added foods when processed foods are necessary. Remember that "no salt added" does not always give a zero sodium count, but will reduce it greatly. You have much more control. Choices are out there. Take your homemade stock and fresh veggies, rice, vermicelli, etc., for lunch at work, in place of high sodium sandwiches. There are low-sodium/low-fat lunch meats available, but you will do better to cook a little extra for dinner or cook a chicken or fish to use for lunches and increase your vegetables and fruits. Pack a salad, keeping tomatoes and cheeses separate, then heat a tortilla and roll up a salad for lunch, with your choice of dressing. Fat-free sour cream and a bit of salsa together make a nice change from the usual. Cook rice and pasta with a minimal amount of salt. If you are combining the rice or pasta with other foods in a recipe you can often skip the salt altogether, as the other foods and spices will flavor them for you. Beware particularly of low-fat/fat-free processed foods. Quite often there is an "exchange" for flavor and that exchange is lower fat, higher sodium. Indulge in all the fresh fruits and vegetables. Season them with other spices and herbs. A minimal amount of salt, if any, and added garlic, basil, lemon, vinegar, lemon grass, chive, cilantro, ground pepper, crushed red pepper, mustard powder, fresh chilies, ginger, cinnamon, etc., can help to retrain your taste buds to a lower sodium diet without making you feel as though you are being punished. Joy in the cooking, enjoy the eating! It is best if you add the salt after you cook, to avoid building layers of sodium in your preparation. All your ingredients will have worked together by then and a light touch with the salt afterward will reward you for being good. Sometimes you may find it necessary to serve a large group of people. If they are not used to your sodium restrictions, you can handle it in basically one of three ways: Fix your meal as you normally would for you and tell everyone you are a low-salt cooker and you won't be offended if they wish to add salt; cook as you do normally and say nothing - just make salt shakers available to your guests; or separate some of the food out for yourself before adding an appropriate amount of salt. We love to cook, but there are those times when we just want to be pampered. Let someone else cook, serve, and clean up. So, you are Eating Out. Now what do you do? If you have ever requested "no MSG, please," you are well-practiced for this. You can request a low-salt treatment of your food preparation. Ask that no additional salt be added to your food. I once asked for this and had a waitress say, "Oh, but they don't add any extra salt to your food." I just asked her if she would please relay my request to the kitchen anyway. Sure enough, she was nice, probably thought I was wonky, but she did relay my request. My plate came out marked with a cute little green flag. When my husband tasted his food and mine, it was obvious the kitchen had complied with my request. No fuss. That is the only time I have ever encountered a wait person that reacted as though my request was unusual.   Another tip for eating out - which is helpful for low-fat restrictions as well - is to ask that your salad dressing or gravy be served on the side. You can dip in a little, still enjoy the flavor, and consume far less salt and fat than you would by having your food doused. FAT/CHOLESTEROL I am combining these two because they so often combine themselves as dietary restrictions. If you haven't tried them recently, fat-free dairy products and low-fat soy dairy alternatives have come a long way in the past few years. The cholesterol count is always considerably lower than the full fat choices. Soy alternatives are usually located in the produce area. You might be surprised what you find there! Soy protein alternatives can also be quite good when well-prepared. An example using a soy protein product is my recipe for Tomato, Eggplant and Italian Sausage Soup. I have included it in the recipe section below. My husband loves the soy Italian sausage in this recipe, on pizzas, and in other dishes. Believe me, he is the original "meat now" kind of guy. For those burger cravings, mushroom garden burgers are mouthwatering when quickly grilled (indoors or out), covered with olive tapenade, a slice of tomato, lettuce, and a toasty bun (with or without melted soy cheese) and your choice of low-fat dressing. Tofu. Experiment with this if you have never cooked with it before. Delicious in stir-fry, for adding to soups, or baked and topped with sauce. Nuts contain good fats and can be good for you in moderation. A naturally cholesterol-free food, nuts add protein variety to a diet. Olive oil is a good fat. The newer Light Olive Oils, although not lighter in fats, can be used in recipes that call for a vegetable oil, as they do not carry the distinctive flavor. Adding a mashed sweet potato to your bread/sweet roll dough will moisten it, lend a touch of sweetness before the addition of sugar, etc., and impart a beautiful rich golden color. Adding a mashed baked or boiled white potato to your bread dough will lend moisture and a rich texture. The applesauce trick works. You can add applesauce to your cakes, sweet breads, muffins, and chewy cookies in place of the requested fat. You can also find light  fruit-based baking products developed for substituting the fat in your sweet baking recipes. Low-fat and fat-free sour cream is a great substitute for fat in your biscuit, corn bread, and yeast bread recipes, imparting  rich flavor while lessening your fat and cholesterol intake. Low-fat or fat-free sour cream, as well as yogurt, make wonderfully creamy and delicious dressings. Use ricotta cheese, low-fat or fat-free, with the sour cream or yogurt, and herbs, for potato and pasta salads. The dressing will supply you with far less fat and cholesterol, and more nutritional value than the usual dressing. Yogurt is also a good dressing for fruit of all kinds. You can pair a fruited yogurt with your recipe, or blend it with juice. Egg white-based products can work quite well in many recipes calling for whole eggs, including baking. You can also make wonderful omelettes, migas (Mexican scrambled egg dish with strips of corn tortillas, tomatoes, onions, and hot peppers cooked with the eggs, and then covered with cheese), and Spanish tortillas using these products, as well as chopped egg for salads, and stir-frying. Instead of frying corn tortillas in oil, spray each side with butter flavored cooking spray and heat for about 15 seconds per side until soft, on a griddle or large heavy skillet for use in enchiladas and other recipes. Saute and grill your vegetables and potatoes using a flavored cooking spray. This is also great for use in oven-fry recipes; I have included three in the recipe and resources section below.

[eGCI Team]

COOKING AS A PERSON WITH DISABILITIES: RECIPES AND RESOURCES RECIPES Now that we have run through a primer, I thought you might like to cook a little dish using some of the methods and suggested ingredients in this topic. I have included several recipes to get you started. The recipes included in this section are rated for: (Ease of) hand dexterity; (smooth) texture; low-sodium (less than 100 mg sodium/serving); reduced sodium (200 mg or less sodium/serving); low-fat (7 g or less/serving); reduced fat (less than 12 mg/serving); low-cholesterol (less than 10 mg/serving). The amounts stated at the bottom of the recipes, when present, are good estimates only, falling within these parameters. Tomato, Eggplant, and Italian Sausage Soup (Hand dexterity; lower sodium; low-fat; low-cholesterol) This is a nice garden soup anytime, great for end of the season harvest. Serves 5 to 6 as a main course (2 cup serving plus pasta) Ingredients 3 links Italian sausage (I prefer the soy, OR use meat) 1 T olive oil 1 large sweet yellow onion, coarsely chopped 4 cloves garlic, minced (I use the fresh jarred garlic) 3 cups Japanese eggplant, halved lengthwise and sliced 1/4 inch OR your choice of eggplant 8 oz sliced white mushrooms 3 to 4 sweet banana peppers, sliced in 1/4 inch rings, OR 1 medium diced sweet red bell pepper   2 cups low-sodium/fat-free vegetable OR chicken stock 8 medium tomatoes, seeded and diced, OR 2 lbs. canned, no salt added, diced 1 T each fresh oregano and basil, OR 1 1/2 tsp each if dried 1/2 tsp crushed red pepper, or to taste 1/4 tsp salt, or to taste 6 to 8 ounces red wine (not cooking wine which is loaded with sodium) 2 cups or more water 3 cups cooked pasta; about 1/2 cup pasta per serving. pick a nice shape. Do not add directly to soup. Method Gather all ingredients into a space next to your work area. Prep each ingredient, placing in a bowl or plate and set aside into that holding area for your mise en place. Return any remaining ingredients to their places. Mise en place for soup Slice peppers and eggplant with pizza cutter, set aside. Slice onion with pizza cutter then lay out slices and roll cutter through again, across the layers, to dice. Set aside. Heat skillet over medium heat for a few minutes; spray with olive oil cooking spray. Brown the sausages in whole links until nicely deep golden. Remove sausages, add minced garlic, sliced peppers, and chopped onion, with 1 T of olive oil, or more non-stick olive oil spray. Stir to coat. Using pizza cutter again, slice sausages in 1/4 inch rounds, return to skillet with onion mixture, add sliced eggplant and mushrooms. Stir and cook until onions and eggplant are slightly tender, about five minutes. Place all in your soup pot on medium heat. Add 2 cups chicken broth or vegetable broth and 2 cups water. Add tomatoes and 2 bay leaves. Cook just to a beginning boil, lower heat, add oregano and basil. Simmer, covered, for 30 minutes. Soup can simmer on low for hours, and is a good choice for your crock pot; may need to replace 1 cup or so water. Add crushed red pepper and salt, adjust to your taste. Now add 6-8 ounces red wine. Let soup simmer on low heat, covered, for another 30 minutes or so. Shortly before you want to serve, cook some interesting pasta, al dente; pick a shape, the pennes, rotinis, and small "horns" all do well with this soup. 1/2 serving pasta per person (1/2 cup, cooked). Ladle the soup generously over pasta in the bowl. (The pasta is prettier, and will not lose its shape or "bite" if you keep it separate until serving soup. You may have left overs; this soup is even better the second day, as most soup is. Keeping the pasta separate will reward you with a finer meal.) Serving soup Serve with fresh grated Parmesan and/or Romano cheese, and garlic toast. A side salad is always nice, and basalmic vinegar and olive oil dressing with some fresh chiffonade basil in your green salad is a very good accompaniment for this meal. Per serving (6), as prepared with soy Italian sausage, the soup has 5 g fat (including the good fat you are consuming with the olive oil and soy product) and 0 mg cholesterol. Parmesan cheese will add: 93 mg sodium; 2 g total fat (1 g saturated fat); 4 mg cholesterol; 25 calories per Tbsp serving. Seasoned Oven-Fried Potatoes with Juicy Oven-Fried Chicken Seasoned Oven-Fried Potatoes with Juicy Oven-Fried Chicken and a salad I promised to include an oven-fried meal for those who are craving the fried goodies and are not supposed to yield to temptation. This meal works out well as chicken or fish and potatoes take the same amount of time at the same oven temperature. You can switch positions of the two pans on the oven racks half way through baking time. While they are baking you have time to make a salad, or steam some veggies to go with the meal. Butter flavored (my preference, or other choice) cooking spray is essential here, don't leave the store without it! I also use the olive oil spray for some recipes, but as olive oil is a good fat, I like to utilize that when possible. I am sparing with all fats, but we do need some in our diet. Seasoned Oven-Fried Potatoes (low-fat; low-cholesterol; low-sodium) Preheat oven to 425º 20 to 25 minutes baking time 15 minutes prep time Ingredients   One large baking potato (serves two; fix all you need!) OR two fingerling potatoes per person Butter flavor (or your choice) cooking spray Cajun seasoning (lower sodium) or a mixture of any of these: garlic powder/red pepper or paprika/fine ground black pepper/finely crushed or ground dried basil/onion powder/pinch of salt Method   Scrub potato(es), but do not peel. Cut potato in slices crosswise, about 1/4" thick. If using fingerlings, cut lengthwise into slices. The thinner the slices, the crispier your oven fries will be. You can make these as potato chips, but watch carefully after 15 minutes and reduce baking time by at least 5-7 minutes. Potatoes sliced thin with pizza wheel on spouted cutting board Spray shallow baking pan (cookie pan) lightly with cooking spray. Lay potato slices out in one layer. Spray with cooking spray. Sprinkle with seasoning. Turn to spray other side. If you like them really spicy sprinkle seasoning on that side also. You can set these aside for up to an hour before placing in the oven. Bake in 425 oven for 20-25 minutes, turning pan after 10-15 minutes. Fat 0 mg; cholesterol 0 mg; sodium will vary, based on the seasoning used, as stated it will be approx 150 mg/serving Potatoes in pan ready for the oven Juicy Oven-Fried Chicken (Hand dexterity; low-fat; low-sodium) Preheat oven to 425º 25 minutes baking time Preparation time 15 minutes I use a 2 mg fat blue cheese dressing for this, usually, but the creamy Caesar is also good, and you can experiment with your own favorites. Ingredients Butter flavored (or your choice) cooking spray 4 boneless/skinless chicken breasts 1/2 to 2/3 cup 2 mg fat/per serving blue cheese dressing 2 to 3 dashes Tabasco sauce (optional) 1/3 cup flour 2/3 cup fine breadcrumbs (the Parmesan is good, but your choice) 1/2 tsp garlic powder 1/4 tsp paprika or ground red pepper seasoning Method   Mix together flour and breadcrumbs with seasonings. Spray pan with butter flavored cooking spray. Rinse and remove any large fatty pockets from the boneless, skinless chicken breasts. Lay chicken breasts out flat, then brush with dressing (with optional Tabasco sauce) to coat. Dredge breasts through breadcrumb mixture, coating all over. Do not over-coat the chicken by dredging twice. Place inside surface down on pan so pieces are not touching. Spray lightly with cooking spray. Bake at 425º for 25 minutes, turning pan after 15 minutes. Chicken ready to go in the oven Cajun Oven-Fried Catfish (hand dexterity; low-fat; low-sodium) Serves 3 to 4 Preheat oven to 425º 25 minutes baking time Preparation time 10 minutes Ingredients 1 lb catfish nuggets 1/2 cup cornmeal 1/8 cup flour 2 tsp Cajun seasoning 1/2 tsp garlic powder juice of 1 lemon butter flavored cooking spray Method Mix cornmeal, flour, Cajun seasoning and garlic powder on a deep plate. Rinse catfish in clear water. Carefully remove skin, if you wish. Spray shallow baking pan with cooking spray. Squeeze lemon juice all over the catfish pieces and cover, let rest for a few minutes to absorb the lemon. Roll in the cornmeal mixture and place on baking pan, skin side down. Lightly spray fish with cooking spray. Bake for 25 minutes at 425º. Do not turn. Serve either the chicken or catfish with Oven-Fried Potatoes, and a big leafy green salad or steamed vegetables. Hearty Bay Scallops Chowder (*low-fat; **lower sodium) Servings: 4 as a main dish, 8 as a soup Another one-pot meal, this chowder utilizes bay scallops which require no cutting. You will need your blender to puree the base. Your pizza cutter will come in handy for cutting.   Ingredients 2  medium sweet yellow onions/diced to 1/3 inch 1 T unsalted butter 1  large baking potato (3/4 lb) 1/2 c beer 1  large fresh thyme sprig (or one large dried sprig) 1/4 tsp white pepper, or more to taste 1 lb bay scallops 3 c vegetable broth 1 c chicken broth 2 c baby carrots cut in 2 or 3 pieces 1  ear kernels from cobbed fresh corn (OR 1 cup frozen) 1  lean pork chop (1/2 lb) diced to 1/2 inch 3/4 c skim milk 1/4 c fat-free half-and-half 1/4 tsp salt, or to taste garnish for 4 to 6 servings 1/4 c bacon crumbles 1/3 c grated sharp cheddar (fat-free or regular) Method Gather and prep all ingredients first; dice onions, wash and dice potato into 1/3 inch, cut carrots, dice pork chop. (If necessary, you may parboil the potato and carrots whole first, before dicing.) Set up your blender in your work space. Reserve all but 1/2 cup diced potato in cold water for parboiling with carrots and corn. Cook 1 onion in butter in covered 4 quart heavy saucepan over low heat until very soft, stir occasionally; 10 minutes. Reserve the other onion to cook with diced pork chop. Add beer, thyme sprig, and white pepper to onion and boil down about a minute or so; most of liquid will be evaporated. Add 1/2 cup diced potato, 1/2 cup scallops, vegetable and chicken broths, then simmer, uncovered, about 20 minutes; potato should be tender. Cook the reserved potato with carrot, and corn in boiling water, until tender, 5 to 10 minutes. While that is parboiling, discard thyme sprig. Carefully purée soup base in several small batches in a blender until very smooth. Transfer puree to a bowl. Cook diced pork chop with 2nd onion, until pork is cooked through and onion is tender. Return puree to pan with pork and onion, then drain and add vegetable mixture,  milk, half-and-half, and salt. Cook chowder for several minutes, stirring over medium heat so that it does not reach a boil. Add the remaining scallops and continue stirring until scallops are just cooked through, for about 2 to 3 minutes. Serve sprinkled with 2 tsp bacon crumbles, and 1 tbsp grated sharp cheddar. I like to serve with small thin sourdough toasts on the side, but you can serve with Oyster crackers or other similar crackers. A green salad completes your meal. Each two cup serving of chowder (not including crackers, or whole fat cheddar) contains about 290 calories and *7 grams fat. **The sodium will depend on your stock and salt additions. You can minimize that greatly by using your own low-sodium stock, as I do. SIDE DISHES Cauliflower Parmesan (Texture; hand dexterity; low-sodium; low-cholesterol) Serves 3 to 4 This is so easy and similar in consistency and taste to cheesy garlic mashed potatoes, but more nutritious. I love the fresh jarred, minced garlic; saves my fingers from the knife. 1 head cauliflower/cleaned, reserving the leaves/remove large stalk 1/2 cup shredded Parmesan cheese (OR Parmesan and Romano mixed) 1/4 cup light margarine (OR butter) *1/2 medium sweet onion/ grated 1-2 cloves garlic/ finely minced salt to taste Steam cauliflower head or pressure cook until very tender/adding the leaves for the last 2 to 3 minutes in steamer or final minute in pressure cooker. Saute the grated onion and the garlic in margarine or butter, just until tender, but not browned. Mash with the cauliflower and cheese, adding cheese a bit at a time, salting to taste. Serve with the leaves as side garnish. *You can use your food processor to prep the onion, if a hand grater is difficult for you. I have used both methods to equal success. Simple Curried Sweet Potatoes (Texture; hand dexterity; no cutting necessary; low-sodium*; low-fat**) Ingredients 4 fresh sweet potatoes (not giants) 1 cup lite coconut milk 1/2 cup peanut butter (smooth works as well as crunchy; reduced fat is fine) 1 tsp-3+ tsp curry powder (mild for younger or sensitive palates/digestion; we like it hot) Method Cook sweet potatoes until well done: bake @ 450 for one hour; OR boil for 35-45 minutes; OR pressure cook for 10-12 minutes. Cool a bit and hand peel; peels will slip off quite easily. Return to pot on medium low to medium heat. Pour in coconut milk. Stir/wisk to mash. Add peanut butter of your choice and stir to blend. Stir in curry to taste. I do not add extra salt to my serving, but you may salt to taste. You can serve as is or garnish with roasted pumpkin seeds or peanuts. (Remember to check sodium for the garnish, if that is an issue.) Sodium approx 30 mg per serving, fat approx 4 mg per serving ("good fat" from the peanut butter) Apricot Nutty Rice (Hand dexterity; lower sodium; low-fat; low-cholesterol) Serves 6 to 8. You can enjoy this as a baked rice side dish anytime, or, as we often do, *baked in acorn squash halves. It is a family favorite at Thanksgiving. Ingredients 1 small box wild rice (1/2 cup) 1/2 cup brown rice 3 1/2 cups water 1/2 tsp salt 1 tbsp butter Orange/Peach/Mango juice 3 tbsp brown sugar 6-8 dried apricots, diced 3 tbsp light margarine OR butter 1/3 cup pecan pieces 1 tsp ground cinnamon 1/2 tsp ground ginger 1/3 cup carton egg product OR 1 large egg Method Bring to boil wild/brown rice together in water w/salt and butter, reduce heat to low and cover, cook for 50 to 55 minutes. Use kitchen shears or pizza cutter to dice apricots. Drain water from rice into measuring cup. Add enough orange/peach/mango juice or orange blend of your choice to make 2/3 cups. Add apricots and pecan pieces to rice. Mix brown sugar, cinnamon, ginger, butter, and egg with juice. Pour over rice mixture. Stir lightly, scoop into 6 acorn squash halves or into a 1 1/2 qt casserole. Bake at 350º for 30 to 40 minutes. *If stuffing the squash, split and cut flat bottoms on ends for squash to sit upright once filled. Scoop out seeds, spray with butter spray and sprinkle with cinnamon and ginger. Then bake cut side down in 350º oven for about 20 minutes. When you remove the squash you will then turn it over, filling centers to mounding with rice mixture. Spray again with butter spray. Return to oven and continue to bake for another 30 minutes. 200 mg sodium, 2 g fat (5 g fat with real butter), 0 mg cholesterol. Texas Sourdough Potato Skillet Bread (Low-sodium; low-fat; low-cholesterol) A different and easy dinner skillet bread, that requires very little kneading. You may your food processor to form the basic dough, then only knead in the cornmeal. This is a delicious change served with lunch or dinner. It is especially well suited to serve with grilled meats, and hearty soups or beans. This is not a strict sourdough bread, as there is the addition of yeast, due to the softness of the dough. But you can enjoy it anyway. The recipe is very simple in its basic form and it disappears quickly. You can change the character for variety, by adding cheese, onions, or peppers. For cheese bread add 1/2 to 3/4 cup of your choice grated cheese to the dough; either when you knead in the cornmeal at the end, or as a topping for your loaf. I also like to top this bread with about 1/3 cup olive tapenade, or sliced olives, if you prefer. Serve olive bread with a smoked chicken, corn on the cob and a tossed salad, or sliced ripe tomatoes, for an easy bbq meal. Ingredients 3/4 cup sourdough starter, set out in the morning 1/2 cup warm water 1/2 cup bread flour 1 tbsp yeast 2 tbsp sugar 1 large potato, boiled, and peeled, grated 1/2 cup potato water, warm 4 to 5 cloves garlic, minced 1 tsp salt *1 1/2 tsp lemon pepper 1/4 cup light margarine or butter 2 cups bread flour 1/2 cup cornmeal **1/4 cup light margarine OR butter for coating dough Method Combine first five ingredients for sponge; allow to set for 3 to 4 hrs in open bowl away from drafts. Boil, then cool and slip peeling from the potato. Grate potato; should be about 1 1/2 cups grated. Stir down the sponge; stir in grated potato and warm potato water with the garlic, salt, and lemon pepper. Stir through the 1/4 cup butter or margarine. Add flour 1/2 cup at a time. Mix in with wooden spoon then knead by hand until a very soft dough. Knead in the cornmeal. Form into ball and place in buttered bowl; coat with softened light margarine or butter. Cover dough and allow to rise until doubled, about 45 minutes. Turn out into a well buttered 8 or 9 inch skillet. Coat again; cover loosely with plastic wrap and allow to rise again for 35 to 45 minutes. Bake in 425º oven for 25 to 30 minutes until nicely browned on top and done. *You can find salt-free lemon pepper if sodium is an issue, or reduce salt in the dough accordingly. **Butter flavored cooking spray is a good substitute for coating dough, and for buttering your skillet, that yields less fat, calories, and sodium. Smoked Salmon Spread Serves 10-12 (2 Tbsp serving) (Hand dexterity; low-fat; low-cholesterol) This is very good with french bread or crackers as a party dip, and makes delicious sandwiches when served on toasted bread with tomato and lettuce. Ingredients 8 oz smoked salmon 6 oz softened fat free cream cheese 1/4 cup sour cream 2 to 3 Tbsp minced fresh chives 2 Tbsp fresh dill OR 1 Tbsp dried 2 Tbsp fresh lemon juice 1 tsp Worcestershire sauce 1/4 to 1/2 tsp lemon pepper (to taste) 1/4 to 1/2 tsp garlic powder (to taste) Method Remove skin from salmon and discard, then break up salmon into several pieces. Put all ingredients into food processor. Quick Pulse several times on medium setting until throughly creamed, about 30 seconds total. Spoon into serving dish and chill for at least an hour; up to three days before serving.   *note: the garlic powder gives an easy and creamier result than fresh garlic, unless you want to take the time to roast it and add it as a paste. Per 2 Tbsp serving (approx 1 oz): 1 g total fat; 12 mg cholesterol; 270 mg sodium This is far over a normal amount I would allow myself for sodium in a single food item, because of the smoking process. However, this is a great treat food for me because it is healthy in many other ways, and I love salmon! So I can indulge in this, monitor my other sodium intake carefully during the day and still be OK. Follow up   You can ask questions about this course on the Q&A thread. I am planning to be available online from 8:00AM through 1:00PM, then again from 3:00PM through 6:00PM (US CST) on May 19, when Part I presents, and for several hours each day during the remainder of the three day course. I will also be available for continuing Q&A whenever you are inspired to ask questions or make comments. Please be a little patient, if I am too dizzy to read it may take me up to a few days to post a response. I always make a plan, then if it does not work out I adjust my plan. You are all in my plan. RESOURCES There are thousands of web sites out there with varying degrees of helpful and/or accurate information. We have chosen only a few that we felt were appropriate sources to introduce you to the following topics. New web site for UCP for Advocacy and Info for all Disabilities. You can plug in your own zipcode and they will show you where the local office is for you, or all offices in any state. For a Medical link to info on Diseases and Health Conditions MedlinePlus Healthboards Message board on all different illnesses and disabilities Informational web sites for particular disabilities; providing links to help sites, and to further research and communication. Alzheimer's Disease and Dementia Alzheimer's Education and Referral Center Alzheimer's Disease International Angelman syndrome Angelman Syndrome Foundation Arthritis Arthritis info and Support US National Library of Medicine and NIH for Arthritis Autism Cure Autism Now web site NIH Autism web site Lovaas -- A type of behavior modification therapy for autistic children . Balance/Vestibular disorders Inner Ear Balance and Dizziness Meniere's Information Center Vestibular Disorders Association VEDA   Deaf and Hard of Hearing (HOH) Deafness/HOH The Hearing Exchange-For People with Hearing Loss, Parents, and Professionals, provides good links to products and services as well as information. Cochlear Implant Facts Cochlear Implants ENT.net Epilepsy American Epilepsy Society Epilepsy Neurological Disorders and Stroke National Institute of Neurological Disorders and Stroke (NINDS) For some real world help in coping with your disability: American Physical Therapy Association American Speech-Language-Hearing Association Boardmaker http://www.independe...ng.com/home.asp]Independent Living Aids[/URL] Online shopping, products for people with disabilities. Although this one is titled Products for Seniors, it is more universal than that. Cooking.com has many items for people with grip and vision difficulties that you might not be aware they carry.   This Food Chart has the carb/calorie/cholesterol/fat/protein/sodium count listed per serving for over 1,000 foods. You can't find everything there, but he does cover a lot of groceries! The eGCI course Stocks and Sauces Class as linked in the text of our course in Part I: Dietary Restrictions/Sodium and in Part III: Nausea. This link will take you to the first day of the class which provides a link for the remaining days. Disabilities information web sites for/through governmental sources: Free and Appropriate Public Education is mandated by IDEA '97. U.S. Dept. of Education Office of Special Education   State agencies related to disabilities are often a good place check out. I know the Tx Dept on Aging covers many services useful to people with disabilities, or who are caring for people with disabilities, of all ages. For links in your state see the following web site. For state specific links (including Puerto Rico) to governmental and private organizations, programs, and services for persons with disabilities and special needs in the United States: Independent Life Resources

[eGCI Team]

COOKING WITH DISABILITIES: GLOSSARY Cochlear implant (CI) A prosthetic device that enables a deaf person to hear sound. It consists of an internal coil with multiple electrodes that is surgically implanted in the cochlea, an external transmitter headpiece that attaches behind the ear by magnetic connection to the implant, and a processor that is either a BTE (behind the ear) model with microphone located there, or a body model worn at the belt with microphone on the headpiece. The processor and transmitter are connected by a cable. The CI does not restore natural hearing. See cochlear implants for more details. Fine motor (Ability to control the) muscles used for small movements such as writing, tying shoes, feeding. Gross motor (Ability to control the) muscles used for large movements such as walking, clapping, sitting, jumping. IEP An Individualized Education Plan.  Every student who is eligible for special education must have one.  It is a legal document mandated by Public Law 102-119 also known as the Individuals with Disabilities Education Act Part B (34 CFR Parts 300 and 301 and Appendix C) or IDEA '97.  Comprised of goals to be covered during the school year, it addresses academic, physical, and emotional disabilities. Mastication From Webster´s: From the Greek word mastichan, to gnash the teeth. The common meaning (also from Webster's) is to grind or crush (food) with or as if with the teeth in preparation for swallowing. Mastication, depending on oral motor tone and mouth structure can be easy or difficult. Most of us are able to eat a wide variety of textures -- chewy, crunchy, soft. Most of us can take a bite out of a sandwich. This is not always the case with a person who has disabilities. If one has deficient oral motor tone he/she may not have the capability to chew a bite of steak. Non-typical mouth structure may not allow one to take a bite out of a sandwich. Chewy foods will need to be ground and large pieces of food will need to be cut into bite-sized pieces. Meds Abbreviation for medication. Mental Retardation A person whose IQ is approximately 70 or below.  See American Association on Mental Retardation for more details. The classification for mental retardation is:   Mild Mental Retardation      A person whose IQ is 55-70*   Moderate Mental Retardation      A person whose IQ is 40-55*   Severe Mental Retardation      A person whose IQ is 25-40*   Profound Mental Retardation      A person whose IQ is below 25* The AAMR has also created a classification system based upon support needed for someone who is mentally retarded to function as competently as possible.  These classifications include Intermittent, Limited, Extensive and Pervasive.  See the AAMR web site for more details. *all numbers are approximate Non-verbal behavior behavior expressed through facial gestures, body language and, physical movement. Occupational Therapy (OT) Occupational therapy is used to help people gain independence in every day tasks. There is a focus in OT on fine motor skills -- everything from picking the marshmallow bits out of a bowl of Lucky Charms to pulling up pants and zipping jackets. OT may also focus on play and often overlaps with Speech Therapy and Physical Therapy. OT in conjuction with Speech Therapy can often recommend eating implements and drinking cups and glasses. See The American Occupational Therapy Association for more details. Oscillopsia A vision disorder caused by the loss of vestibular function resulting in the illusion that objects are bobbing up and down, to and fro, or back and forth.   Oral motor (The ability to control the) muscles of the mouth, including the tongue. PCS Picture Communication Symbols Picture symbols used with people who cannot communicate verbally or have trouble reading. Programs such as PECS and Boardmaker are available for facilitation. Physical Therapy (PT) To aid in gross motor coordination. A physical therapist can also help with positioning and seating. American Physical Therapy Association Proprioception The relation of the body to its own parts and the earth provided by information interpreted by the brain from sensors located on muscles, the skeleton and ligaments that detect movement and position. Speech Therapy (SLP) Most Speech Language Pathologists would prefer to be referred to as "Communication Specialists."  In addition to working with a person on communication (verbal or non-verbal), they may also employ methods to aid in oral motor tone. American Speech-Language-Hearing Association Vestibular compensation/substitution The balance system can adjust for the loss of some vestibular function -- even the total loss of one side -- through compensation by delegating the job to the other inner ear, vision, and proprioception elements. If most or all of the inner ear vestibular function has been lost on both sides the system wants to step up utilizing substitution for that loss by handing the job over to the eyes and proprioception. However, neither compensation nor substitution guarantees the balance system will return to perfect working order and the attendant vestibular issues will no longer exist. Vestibular disorders There are many causes for vestibular disorders.  Acoustic neroma (vestibular schwannoma), autoimmune inner ear disease (AIED), Cogan's syndrome, dysautonomia, hyperthyroidism, hypothyroidism, migraine, multiple schlerosis, perilymph fistula, and otosyphilis, as well as Meniere's disease. Vestibular disorders can result in a variety of symptoms including balance/mobility issues, vision problems and coordination problems. For further information on these and other vestibular disorders and diseases see the VEDA web site. Vestibular function The three major elements of the balance system are the inner ear, vision, and proprioception.The vestibular system includes the labyrinth of the inner ear, the vestibulo-cochlear nerve (the eighth cranial nerve which transmits both sound and vestibular information, separately, to the brain), the brain, vision, and proprioception. It involves the gathering, transmission and interpretation of information by the brain from the inner ear, proprioception, and vision. Depending on the accuracy of this information the brain interprets the position of the whole body and its parts in relation to each other and the earth, as determined by gravity and movement. If this information or the the abilitlity to interpret it correctly is compromised the vestibular function is disabled. Vestibular issues A person with damaged vestibular function may experience disconcerting symptoms that change the way they perceive the physical world around them and their relation to it. Sensations of floating, falling, or stepping into the ground may occur at times, especially while walking on softer surfaces such as sand or thick carpeting and grass, resulting in unsteadiness and imbalance. Movements and situations that come naturally to most people such as bending over, looking backwards, tilting your head back, walking down the aisle at the grocery store, looking at a computer screen, moving eyes and head simultaneously to track movement, watching traffic moving around you, and attempting to move in dim or dark conditions can cause great distress for someone with a vestibular disability.   Vestibular Therapy (VT) A program of exercises devised to aid the person with vestibular issues gain a level of greater function through the process of vestibular compensation or substitution. The exercises may be taught and monitored through a licensed physical therapist specializing in Vestibular Therapy. A physician specializing in vestibular disorders may prescribe this treatment and may also give the patient exercises to do on their own. (Terms in italics are contained in the glossary.)