Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

June 2012 Independent Eating and Drinking Newsletter

Independent Eating...   is a Wonderful Thing

June Topics:

  • Can We Try This Drinking System?

  • Dysphagia

 

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Can We Try This Drinking System?

Mealtime Partners, Inc. regularly gets inquiries about trying drinking items and returning them if they aren’t appropriate for the individual they are being purchased for. Unfortunately, both Federal and State Health Regulations prohibit drinking systems from being used and then returned. The FDA (i.e., the U.S. Food and Drug Administration) is a federal organization that is part of the Department of Health and Human Services. Its purpose is to protect our health by the regulation of food products, medications, medical devices, cosmetics, and other consumer items including drinking systems. In addition to FDA regulations, each state has its own rules.

Because we cannot allow trials of our drinking systems we try very hard to help people select the best system for the individual who will use it. Some of the things that need to be considered are:

Can the person drink through a straw? If the answer is NO, none of our hands-free drinking systems are appropriate.

If the answer is YES, the following table can assist you in determining which drinking systems are suitable based on the characteristics of the user. A YES in the user profile row of the Table below, indicates that the drinking system listed above is appropriate.

 

 

User Profile:

Hospital Bed Hydration System

Front Mounted Drinking System

Hydration Backpack w/tube Positioning

 Hydration Backpack

Drink-Aide

Has normal suction

YES

YES

YES

YES

YES

Has weaker than normal suction

 

YES

 

 

 

Does not have enough hand movement to lift a straw to their mouth

YES

YES

YES

 

YES

Has poor head and chin control

 

YES

 

 

 

Liquid must be available for many hours without replenishment (capacity)

YES

 (100 oz)

(Capacity varies, usually 12 to 24 oz.)

YES

(50 or 70 oz.)

YES

 (50 or 70 oz.)

 

 (28 oz.)

Spends the majority of time in bed

YES

 

YES

 

 

Wants to drink a variety of liquids including coffee, soda, etc.

 

YES

 

 

YES (but not hot liquids)

The drinking systems with long drink tubes require more suction than those with short tube length (like normal straws). They can access fluids from a greater distance where larger fluid containers (usually, bladders) can be placed, often out of sight of the user. Larger quantities of liquid will require less attention by attendants. However, due to clean-ability, only water is recommended for use with these drinking systems. The use of "sugary" drinks will require frequent cleaning.

The easiest drinking system to clean is the Front Mounted Drinking System, which is a drink holder system so that the user can drink from their own cans, cups, or other containers. These containers are usually either dishwasher safe, or disposable. Straws with these containers are inexpensive and disposable, eliminating the requirement for cleaning.

For more detailed information about the drinking systems referenced in the table, click on the name of the drinking system at the top of each column. For additional information about how to select a drinking system, please visit our website and select “Drinking”.

 

The Mealtime Partner Can Be Used as a Developmental Aid

When it becomes apparent that a child will not develop the fine or gross motor skills to be able to self-feed, using a Mealtime Partner Dining System to assist him/her in eating can help them to master the fundamental eating skills during a more appropriate time frame and accelerate the development of other functional skills. It can also help to avoid learned dependence, and, at an early age, teach them that they can have some control over their lives, regardless of their disabilities. The Mealtime Partner is the only powered assistive dining device that can be used by small children. It has been proven to work with children as young as three years old.
Because proper positioning is so important to independent (and safe) eating, Mealtime Partners, Inc. offers several mounting systems for the Mealtime Partner Dining System. Not only can the device simply sit on a table for use, but its height can be adjusted (for table use) by mounting the device on legs of several lengths. For those who sit in a wheelchair to eat, the device can be mounted on a mounting shaft or on its Support Arm. Flexible mounting methods available for the Mealtime Partner Dining System facilitates positioning the Mealtime Partner in a comfortable position to eat for almost any user. Mealtime Partner Mounted on Support Arm

The Mealtime Partner Mounted on a
Support Arm
For individuals who have limited range of upper body control or who fatigue easily from the effort of controlling their body movement, it is recommended that they use the Mealtime Partner mounted on the Support Arm because it has infinitely variable positioning (within its total range). For more information about the Mealtime Partner Dining System, click here. Click the following link for prices and for ordering the Mealtime Partner Dining System. An appropriate hands-free drinking system should also be considered.
 
The Mealtime Partner Dining System is made in the U.S.A. by Mealtime Partners, Inc.

 

Dysphagia

The word “Dysphagia” comes from the Greek word dys that means difficulty or disordered, and phagia that means to eat. The American Speech-Language-Hearing Association (ASHA) defines dysphagia as “a swallowing disorder”. According to ASHA, the signs and symptoms of dysphagia may involve the mouth, pharynx, larynx, and/or esophagus. ASHA documents have adopted “swallowing and feeding disorders” as the more inclusive phrase for dysphagia. Dysphagia is a swallowing disorder and should be differentiated from difficulties getting food to the mouth that is a feeding disorder. Dysphagia can affect people of all ages but its incidence increases as people age and may be as high as 22% in people over 50 years of age. An estimated 15 million people in the United States are affected by dysphagia.

Some of the indicators that an individual may have dysphagia are a constant clearing of the throat or coughing; a sore throat; chronic heartburn; difficulty swallowing; choking or breathing saliva into the lungs; liquids coming through the nose; a horse or weak voice; a “rattling” sound coming from the chest; and weight loss.

Dysphagia can have many different causes that can be broken down into the following general categories:

Neurological Disorders such as stokes, traumatic brain injury, Huntington’s Disease, Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), and Cerebral Palsy (CP).

Obstructive Lesions that can include cancer of the head and/or neck, and of the esophagus; scarring of the esophagus most commonly caused by gastric esophageal reflux disease (GERD), and, birth defects.

Muscle Function and Connective Tissue Disorders including muscular dystrophy (MD), myasthenia gravis, and Sjogren’s syndrome (www.sjogrens.org).

Swallowing, either while eating or drinking, is a complex function that takes the interplay of approximately 50 pairs of muscles and nerves. It only takes a small interference with this interplay to cause swallowing difficulties. Esophageal dysphagia creates the feeling of something getting stuck in your throat or chest. It can be caused by the failure to open of the valve that opens and closes to allow food to enter the stomach, or by an obstruction. The problem tends to worsen over time. Oropharyngeal dysphagia occurs when the muscles and nerves in the throat are weak, which creates difficulties moving food from the mouth into the throat and esophagus. It can cause gagging or choking when a swallow is attempted. Also, fluids may go into the windpipe or up into the nose. It can also lead to pneumonia. An article titled “Why We Choke” in the Mealtime Partners October 2010 Newsletter provides more details about swallowing and respiration.

Even though people of all ages are impacted by dysphagia it is most commonly associated with the very young and the elderly. It is responsible for an increase in morbidity rates for everyone affected by it and can lead to starvation and dehydration. Swallowing problems significantly reduce the quality of life of someone affected by them.

For children, especially those born prematurely, an inability to properly coordinate the suck, swallow and breathing function necessary to drink can cause gagging, choking and regurgitating. Regurgitating can irritate the esophagus and make eating a painful experience for an infant. The result can be a resistance to eating because of the pain associated with the experience. Failure to thrive can be the result of this type of problem in infants. For babies with neurological impairments the neuromuscular coordination of the oral motor muscles may be deficient or immature and cause an increase in gastroesophageal reflux. In either case the result of dysphagia can be aspiration.

As people age, their risk of developing dysphagia increases. This may be because the onset of several diseases linked to dysphagia is associated with getting older, and/or that muscles associated with swallowing deteriorate as we age. Age-related deterioration of the orophanyngeal phase of swallowing is well documented and is frequently due to irreparable neuromuscular disease.

It is noteworthy that the elderly frequently avoid taking medicine because swallowing pills is difficult or because the medication remains in their mouth for an extended time. In addition, some medications can worsen the occurrence of swallowing problems because they produce a dry mouth which makes eating and swallowing more difficult. 

Treatment for dysphagia can be as straightforward as changes to the food and liquid consumed; its texture and/or thickness. Adjustments to the individual’s positioning while eating and having them remain in a sitting position after eating can help. Medication can be very beneficial in some cases. Also, therapy to make the muscles of the mouth stronger or to increase the tongue movement and improve chewing may help reduce dysphagia. The appropriate treatment will be developed by a physician (possibly in association with a speech pathologist) after a thorough medical examination and an understanding of the person’s history relating to health and swallowing is acquired.

Resources for additional information about dysphagia and its treatment can be found in the following publications: .

ASHA publishes on their website a number of Practice Policy Documents that provide insight into best practices and standards for speech-language pathology relating to the treatment and support of individuals with dysphagia (www.asha.org/publications/). They also publish a newspaper “The ASHA Leader” and several Journals that are excellent resources for information relating to dysphagia.

Also, ASHA’s Special Interest Group (SIG) 13 publishes a newsletter titled Perspectives on Swallowing and Swallowing Disorders (Dysphagia) four times each year. The mission of the SIG is to provide leadership and advocacy for issues in swallowing and swallowing disorders and to serve affiliates who evaluate and manage individuals with swallowing and feeding disorders across the lifespan by supporting professional development, research, education, and communication necessary for delivery of the highest quality services.

An excellent source of information for professionals wanting a broad information resource is the journal Dysphagia which is a multidisciplinary journal devoted to swallowing and its disorder. The journal’s purpose is to provide an international source of information to physicians and other health professionals interested in this emerging field. Its scope includes all aspects of normal and dysphagic ingestion involving the mouth, pharynx, and esophagus. This journal has been published since 1986 and four issues are published annually.

The problem of dysphagia in the elderly is significant enough to prompt Today’s Caregiver Magazine to publish a special section in their most recent issue dedicated to Dysphagia. An article by Roya Sayadi, Ph.D., CCC-SLP and Joel Herskowitz, M.D. provide a clear overview of the problem. Dallas Hall, in another article, relays the poignant story of her grandmother’s problems that developed after she had a stroke.

 

Did You Know? Did you know that when you are feeding someone, it is helpful to wear pants with pockets in them? Throughout a meal, the person doing the feeding loads food onto a utensil and puts the food in the mouth of the person being fed. The pace at which food is served to the eater is determined, to a large extent, by the actions of the person who is doing the feeding. The typical pattern of a meal is that the utensil is filled with food and put into the person’s mouth. Once the utensil is removed from the mouth, the feeding partner returns the utensil to the plate and refills it to get ready for the next bite. This action unintentionally implies to the person being fed that they should be ready for the next bite. Their reaction is to hurry chewing and swallowing the food in their mouth to be ready to receive the food that is waiting. Even if the feeding partner does not intend to hurry the person eating, the fact that a utensil full of food is waiting within their view causes the person to hurry. However, if you have a utensil in your hand it is not easy to refrain from filling it. Therefore, it is advisable to return the utensil to the plate and put your hands in your pockets (or, at least, in your lap) until you see that the person you are feeding is ready for more food.

 






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