For the target group, the basic concern in education, as expressed by this workshop, must be for "catch-up" and remedial services. Underlying all approaches to serving the multihandicapped is the necessity to change attitudes of society, a society which "with its pervasive communication media and everyday reminders of the high values of health, wholeness and physical beauty repeatedly informs the handicapped individual about his difference and his unworthiness."(6) A portion of the task facing those who would change this picture is finding "means of helping the handicapped person achieve realistic ego-strength that accepts his own differences, with the conviction that there are many roads to competance and self-realization in society, not merely that of meeting the normative expectations of the man-in-thestreet or the TV commercial.(6) Basic Principles It was agreed that for some part of their educational experiences all multihandicapped persons should leave the place where they reside, even if at first for short periods only. Such egress may have to be preceded or supported by programming which is brought to them in their residence. Continuity between home and community programs is essential. Five major areas of activity in the development of educational programs for the multihandicapped are: 1. Provision of remedial and catch-up services. 2. 3. 4. 5. Location of required personnel. Development of new approaches to the training and utilization of personnel. Exploration of the governmental role at federal, state and local levels, as it relates to legislation, fiscal responsibility and guidelines for program support. Recognition of the voluntary agency's role in areas of legislative development, fiscal responsibility and the provision of service. The success of any program will depend on the planned and deliberate preparation of (a) the professionals who are to develop, implement and conduct the program; (b) the family, including siblings and appropriate relatives, who must be prepared to accept the programţ and (c) the multihandicapped who must participate in the program. Elements necessary to achieve success include: Consideration must be given to each individual's out-put and in-put, mobility, self care and physical ability, educational achievement and potential, personality (including emotional adjustment and self-concept), degree of social interaction among his peers, with other handicapped and with the general community, orientation toward life and work and the potential for developing independence from continued family supervision. The possible need for a protective service for continuing responsibility should be included in the thinking. Communication and Perceptual Problems Major judgements on the potential of a multihandicapped person are usually made around the problems of neuro-motor involvement, with particular reference to the manner in which the trunk and extremities function. The importance of verbal communication and normal perceptual abilities are frequently not appreciated. Lack of these basic skills may prove much more limiting to the person with cerebral palsy than lack of proper arm-leg function. "The person who is not linguistically adept, who cannot express himself, who cannot engage facilely in a discussion, is severely handicapped indeed. To some degree he is forced into the backwaters of the world around him." Such a person is "strapped with a monumental handicap."(7) Many persons with cerebral palsy have perceptual problems of one type or anothWithout the ability to perceive auditorially or visually, verbal communication is not possible. (7) er. Perception has been defined as "the process by which a particular person, from his particular behavioral center, attributes significance to his immediate environmental situation. Seeing certain parts of the environment as structured, appears to be due to the innate organizing processes of the human organism. An example of this in visual perception is the differentiation between a triangle and a circle..... But perceiving is more than seeing. It is the organizing of what is seen, felt and sensed into a meaningful arrangement related to the already organized system which is the individual."(8) Although many persons with cerebral palsy have communication problems, it is improper and inaccurate to set up a speech syndrome for cerebral palsy.(7) The language performance of each person must be viewed as a unique entity and his language patterns carefully studied. "Cerebral palsy speech" per se does not exist. Everyone is more or less affected by psychosomatics. With the cerebral palsied it is highly probably that there are psychosomatic aspects to their problem. These are not always easily perceived and the individual, himself, may be consciously unaware of the complication. However, the impact of the mind upon the body often muddies up the clinical picture and may have a profound effect in terms of therapeutic improvement. For example, if the individual is unconsciously fearful of taking his place in a competitive society it is quite possible that he will not demonstrate measurable improvement in speech and language therapy despite his potential and the best capabilities of the speech clinician. Where verbal communication is not possible, professional workers must recognize the importance of establishing some means by which the multihandicapped individual is able to express himself. The goal should always be developing the "best possible speech." Emphasis may be placed on the of the typewriter as a means of communication. If the hand. annot be used for g it is possible that head movements or the feet may be adapted to the purpose. With persons so involved that the typewriter cannot be used, use of one of the several types of language boards which have been devised may be considered. Although this approach to language leaves much to be desired it does serve an important need in establishing channels of communication. Even a system of simple gesture patterns, with meanings understood in common by the individual and the clinician, can "open up windows which allow contact with the outside....."(7) Preparation and Implementation To accomplish the programs recommended, a systematic and detailed assessment of where the individual is and where he needs to go must be made. Available personnel and resources must be considered. Included would be the immediate family and the handicapped individual, in conjunction with one or more agencies such as UCP, the local Health Department, the Board of Public Education, Easter Seal Society. Mental Retardation Associations. Homemaker Services, Meals on Wheels and Visiting Nurse Associations. Information should be secured from the major national health agencies. the Library of Congress and local resources as to information currently available through reference materials and bibliographies. It is important to evaluate the equipment necessary to assist in providing the services. Can it be bought or made? Can plans be secured? Can local school work shops or other personnel produce it? To assist in developing a profile of the needs of the individual and the means of meeting them, creation of a specific task-oriented "Workbook for Life Enrichment" was recommended. The Workbook should include audio-visual representation of program and equipment in conjunction with a narrative description of services, goal-oriented to the individual. It should be divided into three major sections: 1. 2. 3. Goals for a homebound person unable to leave his home at the time. Goals for someone who can leave home for short periods. Goals for someone who can leave home to participate in work or other productive life style. Subsections could be developed for: Staff, both professional and volunteer, who would provide the services; The multihandicapped, to prepare for participation, To insure implementation and to build in greater potential, establishment of a tactical force on regional or state-wide levels would be valuable. One member of the tactical force should be a multihandicapped individual. Included also should be a volunteer who can meet with UCP Boards and influence Directors to commit themselves to a policy of serving the "target population"; an administrative expert skilled in processes and mechanics of administration; and program expert capable of training personnel and interpreting and modifying program as needed. Such a group would serve to stimulate local affiliates, provide specialized knowledge, materials and consultations and suggest specific steps for implementation of the program. It would have responsibility, too, for an on-going evaluation of the programs. 17 III. RECREATION Since, as a human being, the multihandicapped adult shares the same basic needs of any other adult, the scope and value of recreation programs are the same for him as for all others. However, areas of difference arise because frequently the multihandicapped have reached adulthood chronologically but, due to limitations during their developmental years, are not yet adults emotionally or psychologically. Restrictions imposed by limitations of mobility and communication, by sensory-motor deficits, neurological impairment and severe social deprivation, esult in arrested or incomplete development and limit their participation in the accepted living pattern of their non-handicapped contemporaries. Recreation for this group goes far beyond preparation for and use of leisure time. Through its programs, opportunities for success, achievement, exploration and progress are provided in fun ways. Values that are not work or academically oriented are promoted. Each participant may be helped to establish meaningful, challenging goals and to follow through to their achievement. The physical, social, mental and emotional well-being of the individual is enhanced. The breadth of activities, both passive and active, is so great that programs may be planned to reach all, regardless of age, mentality, physical condition and environment. Opportunities for success in pleasant, meaningful, challenging fun activities make possible the reversal of the failure-frustration cycle that is far too familiar to the multihandicapped. Participation in recreation programs can provide experiences which were inadequate or totally absent in childhood. Physiologically, the multihandicapped can be stimulated to increased activity. Self-help skills can be improved. Ambulation, dexterity, coordination and cardio-vascular and respiratory functions are improved or maintained. Many individuals eat and sleep better. Social isolation is usually the primary environmental factor in the lives of the multihandicapped; therefore, opportunities for social interaction should be provided. Involvement with the community should be encouraged both by bringing nonhandicapped into the program and by taking the handicapped to community-wide affairs, on trips, etc. Self-determination may be promoted by the individual's having as great a role as possible in planning programs. As his participation in planning increases, his ability to determine his own affairs in other life situations will be enhanced. Communication Information gathering and social interaction are dependent on communication. Recreation programs provide for its optimum development under very favorable conditions. The worker must distinguish between speech and language. The assumption must not be made that inability to communicate verbally is accompanied by inability to understand. Opportunities for communication for those without speech or whose speech is faulty must be built into the program. To insure contact, a variety of media such as oral, written or pictorial material and language boards should be provided. Of great importance and frequently forgotten, the speaker must be allowed sufficient time to express himself and to be understood. Poor communication is not always due to mental and perceptual limitations. Impoverishment of experience may be a major causative factor, with poor attention span and distractability resulting from sheer boredom. 18 Perceptual Problems Perceptual problems constitute an important aspect of the disability of some of the target population. This has been discussed under "Education." (See page 14 and 15) Such problems are generally unrecognized. Specific diagnostic tools are required. Training in this area should be emphasized for the professional recreation worker. Materials, activities and skills may need to be reduced to their smallest components for teaching purposes, then reassembled as the individual progresses. Environmental Problems the The workshop group considered the needs of the target population as it may be found in a variety of environments. One of these concerned the homebound person usually found in the family home or in other family-type settings. In this category there is usually one handicapped person, often too involved, physically or mentally, to leave the home. In some cases the homebound situation arises because the family is not physically able to take the handicapped person out of the home, or there may be no appropriate transportation. Consideration was given to persons living in institutions such as nursing homes, facilities for the mentally retarded or disturbed, residential-custodial and residential treatment centers. In such facilities large numbers of persons may be found, all with a considerable amount of leisure time. The institutional schedule is usually rigid as to choice of activities and time of participation, and most often there is a lack of freedom for excursions away from the premises. In planning programs for persons living in rural areas, the relatively small number of potential clients is a factor. The multihandicapped individual usually resides in the family home. Social isolation is common, due largely to the distance from existing programs, although family attitudes and family orientation to community activities (rarely planned so that the handicapped can be included) must also be considered. Transportation may be expensive and difficult to arrange. Volunteers to assist in such situations are less available than in larger communities. ilities which handicapped persons may use are less available. Also, fac In small communities the number of potential participants for an organized program is still limited but, in general, people are geographically closer than in rural areas and transportation, while still a problem, is not so difficult to arFacilities and volunteers may be limited but, again, not so much as in rural areas. Each small community will display a different distribution of facilities which the worker must explore for potentials. range. In large urban areas, problems related to smallness of numbers, transportation and volunteers are lessened. Usually persons with a variety of handicapping conditions will be found and they will have a wider range of capabilities and interests. A greater variety of facilities exist. Funding programs becomes a greater problem because of the larger numbers involved and the greater degree of impersonality usually displayed in a larger community. Program Activities The multihandicapped learn to cope more adequately with their psychological and educational problems through social interaction and membership in a peer group. Opportunities for success are found in a progression of plans and skills that move |