The goal of this match-pair randomized study is to compare the effectiveness of the standard Audio-Tactile Performance (ATP) technique with a song-based adaptation (ATP/S) in teaching oral hygiene in visually impaired individuals aged 6 to 20 years in Kathmandu, Nepal.

1. Can the ATP/S approach achieve a greater improvement in plaque control, as measured by the Patient Hygiene Performance (PHP) index, compared to standard ATP instruction over a two-week period?
2. Does the rhythmic structure of a song lead to a more continuous improvement in toothbrushing task performance and theoretical oral health knowledge?

Researchers will compare a control group receiving standard ATP with an audio information file to an intervention group receiving ATP with a sing-along song to see if rhythmic auditory stimuli help regulate sequencing and reduce working-memory demands during complex motor tasks.

This study is divided in to 2 groups where visually impaired individuals are allocated after inclusion and exlusion criteria.

In this matched-pair randomized study, 40 VI participants aged 6-20 years were allocated to ATP or ATP/S groups. Outcomes were assessed at baseline, immediately post-intervention, and at two-week follow-up using the Patient Hygiene Performance (PHP) index, a 16-step toothbrushing task analysis, and an eight-item oral health knowledge questionnaire. Intra-group changes were analyzed using the Friedman test; inter-group comparisons used the Mann-Whitney U test (p < 0.05).

Inclusion Criteria:

• Bilateral visually impaired in age 6-20yrs. (as verified in school medical record)

Exclusion Criteria:

1. Visual impairment associated with any disabilities that affected arm motor skill/loss of upper dexterous extremity/abnormal mental development/deaf.
2. Using any chemical plaque control agent.
3. Individuals with calculus on examining teeth
4. On medications that could affect the gingival status.
5. Inability to brush due to pain from severe caries/oro-mucosal conditions.
6. Have less than 4 teeth in each quadrant.
7. Presented with orthodontic or prosthodontic appliance.
8. Subject with good oral hygiene ; plaque score = 0
9. Un co-operative children.

Dental Examiners:

Two dental examiners were blinded to the group assignments (Control vs. Intervention). This was critical to ensure that the measurement of PHP scores, the evaluation of toothbrushing task analysis steps and the oral health knowledge were not influenced by whether the student used the standard audio or the song.

two schools were randomly allocated in un-named envelop and picked on the day of intervention