Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

October 2013 Independent Eating and Drinking Newsletter

	October Topics: Introducing Powered Dining Equipment to Young Children Using Your Head

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Introducing Powered Dining Equipment to Young Children

Mealtime Partners is often asked when is the right time to introduce powered dining equipment to a young child. There is no one specific answer to this question as each child’s needs and abilities are different and the answer must be derived from examining the child’s situation.

Prior to evaluating the abilities of the child an assessment should be made of why a powered dining system is being considered at this time. Questions to ask include:

Is a powered dining system being considered to facilitate reaching developmental milestones for a child who does not have the ability to finger feed or use a utensil?
Is this a temporary measure that will be a stepping stone to self-feeding using the traditional method of utensils and hands?
Has the child had any experience with assistive technology like adaptive switches, communication devices, or a wheelchair?
Has the child eaten by mouth for at least 3 months? (This does not mean that the child should have eaten exclusively by mouth for this time period, but that they have experienced oral eating to a point that they are comfortable with the experience.)

For a child who is identified as being unable to feed themselves in the traditional manner, early introduction of a powered dining system allows them to gain independence in a significant activity of daily living. It provides a practical way of exposing a child to their ability to participate in their own care. Also, food is a great “reward” for effort and an activity, for most children, that they thoroughly enjoy; and, to control their own eating is typically very exciting.

If the device is to be a temporary method of independent eating, the length of time that it will be used should be assessed. For periods of less than 6 months to a year, the financial investment and the child’s effort to learn how to use the equipment may make it difficult to justify. However, for some children, using a powered dining system may be temporary in the sense that eventually they may be able to feed themselves using their hands and utensils, but it will be a capability that will not develop soon. For them, using a powered dining system in the mean time, can allow them to experience the concept of independent eating at a developmentally appropriate phase of their cognitive development. Later, when they are able to use their hands and arms to hold utensils and use them appropriately, they will have already developed the understanding of self-feeding and will have an age appropriate concept of how to eat.

If the child has had no experience using assistive technology, to introduce a dining system as their first experience may be intimidating. This is not necessarily the case for all children. Some are fascinated by buttons and machines and are excited by the opportunity. The child’s personality will dictate how they may react and thus should be considered.

For children who have been tube fed for an extended time, the experience of oral eating should be well established before introducing a dining system serving solid foods. This will prevent the child from reacting defensively to a “machine” that is presenting food. This is especially true for children who have oral aversions or are tactilely defensive when their face is touched. However, on the opposite side of how a child may react, many children with these problems find controlling a device that offers them food a much safer way of eating. They are in charge of it and control when they put food into their mouths, and thus, are often more receptive to the whole eating process. When they are fed, the person feeding them chooses when food goes in their mouth. Additionally, when someone puts a spoonful of food into their mouth, the quantity may be more (or less) than they would choose if they were in control. Therefore, a dining device facilitates the child managing when and how much food they will take for each bite. They are able to chew and swallow at their own pace and take the next bite as slowly, or quickly, as they choose.

Other questions to be considered are the physical size of the child. Access to all powered dining equipment has a size restriction. All powered dining devices except the Mealtime Partner Dining Device are designed to be used by adults or adolescents, not small children. To be able to reach the Mealtime Partner Spoon when sitting at a table, a child's mouth needs to be at least 6-inches above the surface of the table. A typical 3 or 4 year old child will be this size.

It should be noted that a good seating system is a wise choice for mealtimes regardless of the child’s abilities. Some highchairs position the child at an appropriate upright, or slightly forward position. However, many cause the child to recline slightly which is not an appropriate position for eating solid food. A physical therapist or occupational therapist can help with selecting a good chair for mealtimes.

If a child has developmental delays, the concepts that they are able to understand are important. Do they understand cause and effect? If this concept has not yet been acquired by the child, it should be understood that the caregiver must be willing to work on developing it if a dining device is to be productively used by the child. Otherwise the acquisition of a dining device should be delayed.

Mealtime Partners encourages the use of two adaptive switches for control of their dining system when it is to be used by children. Sometimes it is appropriate for the child to start out using a single switch that controls the spoon (the spoon switch). Pressing the switch activates the spoon which, once activated, causes the spoon to sweep through the food, picking it up and presenting a bite of food close to the child’s mouth for the child to eat. Each time the switch is pressed a new bite of food is offered. The spoon does not enter the child’s mouth but presents the food close to the lips for the child to lean forward slightly and take the food off of the spoon.

Later, when the child has shown mastery of spoon control using the spoon switch, a second switch can be introduced. The second switch (the bowl switch) allows the bowls to be rotated. Each time the switch is pressed the bowls rotate one place (or one food selection). The significance of using switches when using the Mealtime Partner (besides providing the highest degree of control over the device) is that it provides repetitive use of the switch(es). Eating a snack will produce 10 to 20 switch presses and bites of food. Ten switch presses several times a day will provide excellent repetitive switch use which will help to develop good control. Mastery over switch use will allow the child to transition the skill of adaptive switch use to executing other tasks.

For more information about configuring a Mealtime Partner Dining System for a small child, or other information about the system, visit the Mealtime Partners website, or call us at 800-996-8607.

The Mealtime Partner Dining System is so flexible that it is almost like having a custom designed dining system. From multiple mounting options to adjustable timing, the Partner can adjust to meet the needs of everyone from small children to adults with diverse eating needs.

For those who are unable to feed themselves, the Mealtime Partner Dining System is the best possible way for gaining mealtime independence. There is no other powered dining equipment that even comes close.

The Mealtime Partner and the various mounting systems can be purchased through our online store or by calling Mealtime Partners, Inc. at 800-996-8607.

Child using the Mealtime Partners Dining System

Using Your Head

Needless to say, the head is an all important part of the body for everyone. However, for those who have limited mobility, their head can be a crucial way to perform activities, and in many cases, it is the only way to perform activities. When your head is the only part of your body that you can consistently move in a controlled manner, it becomes your method of doing everything. With this information in mind, it was a natural evolution for a drive control for a wheelchair to be developed that is operated by the head.

The preeminent manufacturer of head controlled mechanisms for powered wheelchairs is Adaptive Switch Labs (ASL). ASL was created by Sandra and Rucker Ashmore after their son Rusty was injured in a car accident and became a C5 quadriplegic. In developing products that provided their son with independent mobility they produced a line of drive control systems that can accommodate the diverse needs of individuals with a wide range of mobility limits. The ASL logo is a familiar sight on wheelchair head controls. However, in developing products for mobility, ASL rapidly recognized the need for access to other functions like computer control, environmental control and access to a communication device. Thus their product line expanded to include these functions, all of which can be accessed through use of the head.

Many individuals who drive their wheelchairs using their head are unable to feed themselves in the traditional manner and must use assistive technology to gain mealtime independence. It is logical to use the same method of access to control a dining system as is used for mobility, communication, etc. However, there are some significant issues that should be addressed when using your head to activate adaptive switches for eating.

When designing controls for driving a wheelchair using your head, the goal must be to safely control the wheelchair and to provide the best possible view of where the wheelchair and its occupant are going. To accomplish this, the head should be in an upright position with the eyes able to scan left, right, and ahead in a range from close proximity to distance. To provide this head positioning, and for it to be sustained over an extended time period, it may be necessary for the chair to be reclined slightly so that the head is supported by the headrest. This position is designed to undertake the task of independent mobility safely. It does not necessarily lend itself to executing other tasks. This is especially true for the task of eating.

The best position for eating is for the body to be upright or even leaning slightly forward. This will cause the head to tip slightly downward which causes the chin to lower. This head position facilitates swallowing with a chin tuck. Therefore, the position that is ideal for driving a wheelchair is not necessarily suitable for eating.

Next, the issues of activating switches for driving a wheelchair are significantly different from those of activating a dining system for eating. When driving, the head should be constantly upright and the back of the head is an excellent location for forward drive controls. To move left or right, the head can move in either direction to cause the wheelchair to move in that direction. The head movement is a natural function of driving and your eyes go in the direction that you wish the wheelchair to go. Conversely, for eating, the head should not tilt backwards to activate a switch because this position is not appropriate for eating and swallowing because it exposes the windpipe to the risk of aspirating food or liquid. Additionally, the head should be maintained in an upright, midline, position. (Midline head position is when the head is positioned above the body in a centered manner, as if there is an imaginary line going through the body and head, and the head has equal parts to the right and left of the line.) The head should not move from left or right as is done when driving a wheelchair. This centered head position allows the spoon to be taken into the mouth with the head in the best position for receiving food.

If head activated switches are going to be used for controlling a dining system, it is recommended that the switches be placed such that they are activated by the cheek bone or temples. They should be positioned very close the person’s face so that the person does not have to make a large head movement to cause switch activation.

ASL has additional switch mounts that will allow adaptive switches to be mounted on their head arrays that will allow switch positioning that is appropriate for eating. For more information on these mounts follow the ASL website link provided above, and browse the Product section of the website.

Not only can a wheelchair, computer, environmental control unit, or communication device, be controlled by someone’s head, an assistive dining system can be accessed using the head. For individuals who are restricted to using their head for all activities, independent eating using a system, like the Mealtime Partner Dining System, provides independence in an important activity of daily living. Not only does it allow someone to choose the food they want to eat and the pace at which they eat, but is a safer way to eat than being fed.

Did You Know? Did you know that you can make your own talking book? In anticipation of the holiday season you might consider making a talking book for a child or for an elderly loved one who has memory problems. Talking photograph albums are available through many sources. A simple Google search will provide many options. For young children and infants, there are books that are child friendly. You can insert pictures of family and friends and record a message for each picture. The child can handle the book without damaging it. For older people, a wide variety of styles are available. Once again you can include a picture of loved ones and provide a short message about who is in the picture.

These books are also very useful for compiling a series of instructions for completing a task. For example, a morning routine can be documented for individuals who have difficulty remembering how to execute these tasks. The book could be compiled as follows: a picture of getting dressed with the appropriate verbiage, followed by pictures and instructions for breakfast, then a bathroom routine including tooth brushing, washing face and hands, combing hair, etc.

Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

October 2013 Independent Eating and Drinking Newsletter

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