Lesson 11: Personal Management, Grooming, and Eating Techniques

Introduction

Many adults with new visual impairments may have concerns about their appearance. Shaving, applying makeup, and caring for and styling hair may seem like impossible tasks without the use of sight. Even keeping toothpaste on a toothbrush or staying oriented when using bathroom facilities may be challenging. Also, adults with new visual impairments may feel embarrassed when they dine in public, prompting them to order foods they can eat with their hands, like sandwiches, to avoid using silverware. Lack of confidence with these daily tasks can damage a newly visually impaired person's self-esteem.

Many people who enter vision rehabilitation training are embarrassed to tell their instructors they struggle with these personal tasks. You may feel the same. This lesson will share suggestions and strategies that have worked for others that experienced vision loss. These techniques may help you regain confidence in managing your appearance and the ability to enjoy dining out.

Lesson Goals

Identify adaptive techniques for putting toothpaste on a toothbrush

Use spatial orientation and organization to move freely and confidently locate and use items in your bathroom

Shave your face or legs safely using skills learned in Lesson 3 or low vision techniques

Identify ways to make hair care more manageable

Describe ways to organize and label skincare products and cosmetics

Apply foundation, mascara, blush, and eyeliner using techniques from Lesson 3

Care for your nails independently with four simple steps

Assess the safety of your bathtub and shower

Develop techniques for eating at home and in a restaurant

Brushing and Flossing Teeth

You have not lost the ability to brush your teeth, but you may have difficulty measuring the right amount of toothpaste or the ability to get toothpaste onto a toothbrush. One technique that can help is placing your index finger on the bristles of the toothbrush. Without squeezing, drag the toothpaste across the bristles along the side of your finger. Do this several times until you get a sense of the size of the bristle. Then squeeze the tube gently as you drag it over the bristles beside your finger. You could also place your index finger on one side of the bristles and your thumb on the other and drag the toothpaste between your index finger and thumb. If you have difficulty keeping the toothbrush level when applying toothpaste, squeeze a little toothpaste onto your index finger instead and then rake it into your mouth with your teeth. Another technique is to squirt the toothpaste directly into your mouth; squirt toothpaste onto your tongue so you can feel when you have the right amount. Press the bristles of your toothbrush into the toothpaste and then brush.

Another strategy used by people with some vision is to buy a brightly colored toothbrush. The dark, contrasting color around the edge of the white bristles may make it easier to apply toothpaste. Storing the toothpaste and toothbrush in a container darker or lighter than the bathroom wall and counter can make them easier to locate. If you share a toothbrush holder with others and are having difficulty identifying your toothbrush, you could put a rubber band around the handle of your toothbrush to identify it.

If you're having trouble measuring the correct amount of dental floss, try wrapping it three or four times around two fingers on one hand and then two or three times around two fingers on the other. Your non-dominant hand will keep the floss taut while you unwind a little at a time from your dominant hand.

Spatial Orientation

Lesson 4 discussed moving safely within an area of your home or other space. This technique is called spatial orientation. This technique can help locate large objects in the bathroom, like the bathtub or trashcan, or for smaller objects on the counter. For example, the space on the counter around the sink can be divided into sections, with oral care items in a corner, shaving equipment in another corner, and so on. Eventually, you will find yourself reaching for those items just as if you could see them sitting there.

Spatial orientation techniques can also help you locate and confidently use objects in the bathroom. One technique can be particularly useful for men to stay oriented while standing to use the toilet. Try envisioning locations around the rim of the toilet like a clock face, with 6:00 being nearest you (at the front of the toilet) and 12:00 being furthest away (near the back of the toilet). Then place your left leg at around the 8:00 position and your right leg at around the 4:00 position, with both legs touching the rim of the toilet. Then move your left leg a short distance straight out to the left of the toilet's 8:00 position, about a half a step. Then, with your right leg, step straight backward about one step from the 4:00 position. This technique has helped some men remain oriented while using the toilet in a standing position. You may need to adjust this technique a bit to accommodate your height.

Shaving

From Lesson 3, you know that your body still remembers how to do tasks you've done repeatedly, whether you have vision or not. This type of memory is called muscle memory. Lesson 4 covered how shaving requires only three skills, and the same three skills are used to apply makeup and do other, similar tasks. The three skills are the use of landmarks, overlapping strokes, and the grid pattern technique.

Before you lost your vision, you may have shaved your face while standing in front of a mirror, visually monitoring your progress. If you have no usable vision, you can still stand in front of the mirror while shaving if you prefer. One strategy is to visualize your face before you begin to shave. Think of the parts of your face as landmarks: each cheek, your nose, upper lip, chin, forehead, and ears. Next, move your right hand over your right cheek, then your left hand over your left cheek. This technique gives you a nonvisual sense of your cheeks' size and shape and will help you use overlapping strokes to remove facial hair. Use an overlapping, circular motion when using an electric razor.

Similarly, explore your upper lip and your chin. Determine the length of your sideburns by comparing their bottom edges to the bottom of your earlobes. It does not matter which part of your face you shave first, but try to always begin with the same area, so you don't miss an area.

If you prefer to use an electric razor, you may need to go over your face more carefully, making smaller circular movements. Remember, it's perfectly fine to go over the same area twice.

Before applying shaving cream, if you are using a safety razor, keep the safety shield on the razor and practice making overlapping strokes on each cheek, upper lip, and chin. Practicing can help you get comfortable with the process before you begin shaving. When shaving your sideburns, try shaving the area around each sideburn first by covering the bottom edges with a finger. After shaving each area, use your fingers to locate the areas with shaving cream.

If you have some usable vision, try hanging a dark or light towel on a door or towel rack behind your head to help outline your face. If you cannot see your face clearly in the bathroom mirror, try using a magnifying mirror about 12-14 inches from your face. Adjusting the light can also make it easier to see what you are doing. Lighting positioned in the middle of your ceiling can cause shadows and lights on the counters, creating glare, visual distortions, and eye sensitivity. A light that illuminates your face but doesn't point directly into your eyes can help.

If you are a woman who is accustomed to shaving in the shower without a mirror, this task may not be too difficult to complete with vision loss. You likely could not visually monitor shaving under your arms even with full vision due to the nature of the angle where you are shaving. These three steps might be helpful when shaving:

cover your leg with a sufficient amount of shaving cream or body wash to avoid a razor burn

Use an overlapping grid pattern as you shave around your leg

Check with your fingers to see if you removed all the hair. If not, go over any areas you missed

A note of caution when shaving your legs while standing in the shower: shower floors can be slippery, and some people become light-headed when they bend over. You may want to try sitting in a shower chair and propping your foot on a small, waterproof stool.

Haircare

For men and women, hair care begins with a complimentary style and haircut for your face. If you have problems managing your current style, ask your hairstylist to suggest an easier style that is still complimentary. Also, ask how to style it yourself.

When you're in the shower, try storing items like shampoo, conditioner, body wash, and soap in a caddy that hangs over the showerhead or shower door. Some showers have built-in places for these items. Haircare products can be placed on one shelf, and bathing products on another. If your shampoo and conditioner are in similar bottles, try putting a rubber band around one so you can distinguish between the two.

Applying Makeup

Begin by organizing and labeling your skincare and makeup products. Skincare products often come in jars, tubes, and bottles that are indistinguishable from one another. Braille users can make word labels for these products. If you have usable vision, you can create labels in large, bold print. Another technique to try is creating single letter labels out of materials you can feel tactilely, like electrical tape, puff paint, or glue. For example, put the letter "C" on your cleanser and an "M" on the moisturizer. Use a basket, tray, or bag to keep skincare and makeup items together. You may prefer to use an electronic labeling device or reader. Label your makeup unless an item is easy to identify tactilely, like mascara. Label each color of eyeshadow, blush, and lipstick.

One way to organize your makeup is to arrange the items you use in the order that you use them. If you use mascara, consider putting it on first. That way, if you accidentally touch the bridge of your nose or cheek with the applicator, you can remove it before applying foundation or blush. If you have uveitis, glaucoma, iritis, or experience eye infections, it's better for your eyes if you don't wear mascara.

You may want to try using facial landmarks, like your forehead, eyelids, nose, cheeks, and chin, as you apply foundation, blush, and eyeshadow. Also, a sponge or makeup brush may help to blend in the foundation smoothly. Try applying consistent pressure and counting the number of strokes you use to load the brush with blush or eyeshadow, and then tap the brush against the side of the sink before applying to your cheeks or eyelids. It may take practice to apply the same amount to both cheeks and eyelids consistently.

Doing some prep work before you put on mascara or eyeliner may be helpful. Use the fingernail of your dominant hand and draw a line just under your lower lashes. Practice this for a few days to develop consistency. Next, use an eyeliner pencil with the cap on to practice drawing lines under your lower lashes. Repeat these actions to develop muscle memory. When you can keep the pencil under your lashes, you are ready to remove the eyeliner's cap. You may benefit from placing the index finger of your non-dominant hand in the corner of your eye to act as a buffer as you line your lower lid. If you are right-handed, place your left index finger in the outside corner of your left eye and put the point of the eyeliner pencil next to it before you start to draw the line. Then put your left index finger on the inside corner of your right eye. If you are left-handed, reverse this procedure.

As you prepare to apply mascara, try using your index finger as a mascara wand and gently stroke your upper lashes. Practice this often until you can stroke your lashes without poking your eye. Next, practice stroking your lashes with the cap on the wand. Finally, remove the cap and place the index finger of your non-dominant hand in the corner of your eye to protect it from the point of the wand as you stroke your lashes. Use the same procedure described above for eyeliner. Some prefer to hold the wand just beneath their upper lashes and blink to coat their lashes. If you have some residual vision, you may be able to use background lighting to line up the mascara wand with your eyelashes.

You may prefer to use softer, more subtle shades of cosmetics to avoid applying too much. It might be helpful to contact a cosmetic consultant and have a makeover. Ask them to observe you applying your new makeup several times until you feel confident with the new skills.

Nail Care

Nails that are clean and filed or trimmed make a positive impression. If you have always kept your nails shaped or trimmed, you probably will be able to continue this task with vision loss without much of a problem. If you have diabetes, you might consider having a professional or podiatrist care for your toenails. Medicare covers the cost of podiatrist appointments for trimming toenails.

If you pride yourself on having beautiful manicured, polished nails, you can still perform this task if you adopt a few adjustments and practice. If you have some usable vision, place a contrasting colored towel under your hand. The contrast will allow each finger's outline to stand out and help you see where to apply the polish.

If you have always painted your nails, consider trying these steps:

Take a dry nail polish brush and stroke across your nails as if you are polishing them. Do this several times, feeling the brush as it touches each nail and getting familiar with the muscle memory as it develops.

Apply a clear polish. Practice with clear polish until you feel confident with your skill.

Keep your nail polish in the refrigerator. It is easier to feel cool polish as you apply it to your nails, and cold polish spreads more slowly.

Finally, try painting your nails with a bright color. Use a manicure stick dipped in polish remover if you get some polish on the edge of your finger or need to clean around a nail. Don't be embarrassed if you make a mistake. Even professionals have to do some clean-up!

It is okay if you don't feel confident polishing your nails. Consider pampering yourself with a professional manicure and throw in a pedicure from time to time!

Bathing

You probably do not have difficulty bathing related to your vision loss, but some safety reminders might help. Your shower and tub and the floor immediately surrounding these areas are some of the most dangerous areas in your home. Always put down a bathmat that is large enough to cover the area where you might drip water getting in and out of your tub or shower. Some shower doors have troughs along the bottom edge that collect water from the shower head. When you open the door to get into the shower, the water in the trough can leak onto the floor. Make sure your bathmat is wide enough to catch the water.

Regardless of age and amount of usable vision, it is a good idea to have safety bars installed in your showers and bathtubs. Having something to hold onto as you get in and out of a bathtub or shower is recommended. Safety bars should also be installed on shower walls so you can hold on as you bathe. Also, slip-proof material on shower and bathtub floors or heavy, slip-proof mats with holes that allow water flow to the drain are recommended for increased safety. Take an inventory of your bathtub and shower and add these safety items to reduce the risk of an accidental slip or fall.

Do you remember the section in Lesson 5 about the upper protective technique? This technique protects your head, face, and chest from open doors and cabinets and anything else you might run into at face level. It is important to avoid bending over without using the upper protective technique. Individuals who are blind or have low vision should use the protective technique in the shower to avoid hitting their head or bruising their face on bathtub faucets or other protruding hardware.

Eating Techniques for Home and Dining Out

If you are newly visually impaired, you might experience difficulty performing some of these common tasks at mealtime:

Locating food on the plate

Pushing food off the plate

Cutting meat and large vegetables, like asparagus or broccoli

Using condiments

Buttering rolls and other types of bread

Eating salad with large pieces of lettuce

Locating a beverage without spilling

Although these problems can occur at home or in a restaurant, it's easier to improve the situation while at home. For example, poor lighting may contribute to locating food on your plate or pushing food off if you have low vision. You can increase the amount of light with brighter lightbulbs or by setting a lamp on the table at home. You can solve the problem of food falling off your plate by using a placemat in a color that contrasts with your plate. For example, a dark placemat under a white plate helps you see the plate rim more clearly. Some people even bring a dark placemat when eating out because most restaurant dishes are white. Solid-colored plates also make it easier to see most foods. Some people with low vision find it helpful to pour coffee into a light-colored cup to see the cup's rim better as the coffee level gets near the top.

If you do not have usable vision, try putting fewer items on your plate. After a few bites, go around the edge of your plate and push the remaining food toward the center with your fork. When eating foods that are easy to push off the plate, like peas or corn, use a piece of bread or your knife blade as a "bumper."

Regardless of how much vision you have, you may find it difficult to locate your beverage on a table. One strategy is to make a loose fist and place it palm down on the edge of the table. Without lifting your fingertips, gently move your hand around the edge of your plate to locate the glass. Once you locate the bottom of the glass, uncurl your fingers and grasp the bottom of the glass. You will likely never turn over a glass if you use this technique, and it works both at home and in a restaurant.

Some newly visually impaired people stop eating salad due to the challenge it presents. This challenge is understandable in a restaurant where salad ingredients are often large. At home, you can break lettuce into smaller pieces, cut tomatoes into small wedges, and slice other vegetables or fruit into bite-size pieces. When dining out, some restaurants offer chopped salads. You can ask your waiter how a salad is served, and if it comes in large pieces, ask to have your salad cut up before it is served.

Even at home, condiments can be challenging. Distinguishing salt and pepper shakers is a common complaint and easily fixed. Salt is heavier than pepper. Unless the pepper shaker is full and the salt is almost empty, you can compare the two shakers and quickly identify the salt. Salt will make a little noise if you shake it, and pepper is silent when shaken. You can label the shakers by putting a tactile marking, like a rubber band, on the one you use most often. Another method is to measure the amount of salt or pepper you wish to add to your food, shake it into your palm, feel it to ensure it is the desired amount, then sprinkle it onto your food. If you have too much, discard the extra on the side of your plate or a side plate.

It's generally easier to control salad dressing, ketchup, mustard, and mayonnaise if you use squeeze bottles. Many restaurants serve salad dressing in small cups; you can either pour it on your salad or dip one bite at a time in the cup. If you like ketchup and mustard on a burger and the containers on your table are not squeeze bottles, pour some on your plate and use a spoon to put it on your burger. Or you can ask the server to bring your burger with the condiments added.

Cutting a steak, chicken breast, chop, or fish filet may take practice. As you try the following techniques, visualize what you are doing. First, use your fork to trail around the outside of the piece of meat. This trailing technique gives you an idea of its size. Next, cut it in half and set one half aside. Now you have the choice of cutting up an entire half or cutting one bite at a time. Find one end of the meat with your fork. Place it into the meat about 1 inch from the edge. Place your knife behind the fork tines and cut as you would if you had vision. Remember, you still have the muscle memory to perform this task. Once you've cut through the meat, lift the fork slightly and slide the knife under the bite you've just cut. If it's cut completely through, the knife will slide under it.

In a restaurant, you may not feel comfortable cutting your meat until you have had enough practice. In this case, you can ask the server to bring your meal with the meat cut. It's not uncommon for even the most confident person who is blind or has low vision to make this request. Make your request with confidence, and don't feel embarrassed. You can order vegetables that you know will be easy to eat or ask for asparagus spears or green beans to be cut in half.

When you serve yourself at home, you know where you placed the meatloaf, the mashed potatoes, and the vegetables. When a server in a restaurant sets your plate in front of you, they may tell you the plate is hot, but they won't say that your meat is at 6:00, your potato at 12:00, your beans at 3:00, and your bread at 9:00 (based on the positions of a clock face). You can ask your server or a companion to tell you where each item is located, or you can use your fork to go around your plate and identify each food by texture.

When it comes to buttering bread, some people who are blind or have low vision choose to eat their roll with no butter or only use it as a bumper. Others practice at home to master the technique of buttering bread. One way to do this is to use a spoon to measure the amount of butter you want. This way, you can scoop a spoonful onto your bread and then either use your knife or a spoon's back to spread the butter. Placing the butter in the center of the bread and spreading it toward you is often easiest. Once you have spread some of the butter, turn the bread clockwise a quarter of a turn and repeat the process to cover the entire piece of bread. This method is also useful for spreading peanut butter, jam or jelly, mustard, mayonnaise, and other condiments.

Summary

Hopefully, you've found many of the techniques in this lesson to be easier than you anticipated. We hope these techniques will help you gain self-confidence and empower you to enjoy socializing around a meal with friends and family at home or in your favorite restaurant.

Suggested Activities

Identify a task where you can increase the contrast of the objects you are using. After trying the task with increased contrast, look for other opportunities to implement this strategy.

Try two different methods for applying toothpaste to your toothbrush.

Review your bathroom for organization and safety. Adjust at least two things to increase your organization and/or safety.