Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

August 2014 Independent Eating and Drinking Newsletter

	August Topics: Considerations About Going Back to School Useful Equipment for Back to School

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Considerations About Going Back to School

At this time of year everyone is preparing for children to go to school. For some it is a new experience, and for others it is a new grade or a move to college. Regardless of the age of the young person, each school year brings with it different challenges. For students who have disabilities some practical considerations must be addressed at the beginning of each school year. How basic activities of daily living (ADLs) are going to be undertaken while in school, must be considered. Typically these ADLs include toileting, moving around school (mobility), communication (expressing wants, needs, completing school assignments, etc.), and eating and drinking.

According to the Merriam-Webster dictionary, a school is: an organization that provides instruction: an institution for the teaching of children. In that capacity schools that serve students with disabilities may need to provide instruction in the basic skills needed to care for ones self. Taking care of ADLs is a function that is ongoing throughout each school day and may require total assistance, or at least some level of assistance from a teacher or teacher’s assistant or aide. As quickly as possible after school starts, a plan should be laid out that will address the needs of each child who is unable to independently perform ADLs. Learning the many aspects of self-care should be set as goals in a student’s Individualized Educational Program, or IEP.

Typically most students enter or return to school with an established method of transport if they are non-ambulatory, such as a stroller for the very young, or a manual wheelchair or powered wheelchair for those who are able to operate one. Additionally, the majority of students who have significant communication deficits will have a communication device if they are cognitively able to use such a device. Toileting, eating, and drinking are the three areas that require a lot of planning and potentially training for staff. Laying out the strategy most appropriate for each student should include the support of an occupational therapist, a physical therapist, and a speech language pathologist as well as the teacher and teacher’s assistant, and the child’s family.

When addressing independent eating for students who cannot self-feed, their current level of performance in the area of eating should be thoroughly evaluated and both how the evaluation was conducted and the results should be documented in their IEP. Having established the student’s current level of performance, the next step is to establish goals in this area. Goals should be prioritized in the order of greatest importance and should be stated in objective, measurable terms.

Establishing goals that address gaining independence in eating should be developmentally appropriate for the student and should, when reached, enhance the student’s ability to participate in the least restrictive environment. However, they should always be realistic and achievable. For example, it may not be realistic to set a goal for a student to take four bites of food independently if the student currently cannot raise their hand to their mouth. During the evaluation, the student’s functional abilities should be measured. If a student does not have a pincer movement, or cannot grasp a utensil, or is unable to raise their hand to their mouth, then intermediate steps must be evaluated as IEP goals rather than setting direct eating goals. The question must always be asked, can these skills be developed? Have previous IEP goals in this area been established, and if so, were the goals met? If the answer is that the goals were not met, then the reason(s) should be examined. Can the student, with more time and practice, develop these skills, or is it unlikely? If the likelihood is remote, perhaps a different approach should be taken. Instead of setting goals that attempt to develop functional skills in the traditional sense which might be impossible to achieve, the student may make great strides towards mastery of independent eating through the use of assistive technology (AT). Equipment like the Mealtime Partner Dining System can enable independent eating when traditional methods fail.

In many cases where children need assistance with eating and drinking, assistive technology can allow them to gain greater independence in the activity. It can be something as simple as using a Dycem non-slip pad under a plate, to something as complex as a powered dining system. The clinical team should include any needed assistive technology in the student’s IEP. If assistive technology is to be used, the method of introducing it to the student and how its use will be measured should also be part of the IEP. Complex technologies, like a powered dining system, should be introduced slowly with logical steps for its use laid out in detail. When using AT to eat, the equivalent mealtime behaviors can be performed and observed. The conditions that meet the IEP goals are the same, yet how they are accomplished changes. For example, the behavior will be observed at lunch-time or at snack time (the same time regardless of whether an aide is helping the student eat using hand-over-hand techniques or the student is using a dining device). The level at which the behavior will be performed will be established (with physical assistance, verbal prompting or independently) and how the acquired skill will be measured (e.g., John will take 4 bites of food with verbal prompting at each snack). Setting goals for independent eating using AT can be compared with setting communication goals using an augmentative communication device.

Because typically the teacher’s assistant is the person who supports children who need to be fed, it is important for them to understand the significance of following the strategy laid out by the clinical team. Stevenson and Allaire, in Feeding the Disabled Child, maintain that “a knowledge of normal feeding development, and the various factors affecting it, is essential to an understanding of feeding disorders in children with neurodevelopmental disabilities” but understanding normal feeding development is not enough on its own to qualify someone to meet the specialized needs of these students. Classroom aides must understand that when they provide food or liquid to a student, they are responsible for the safety of that student and that the risks of choking or aspiration are always present. The therapy team must provide the teacher and classroom aides with instructions to safely provide food and a drink to each student who needs support. This is not a situation where the same practices are appropriate for all students. Diagnosis, physical abilities and intellectual level, impact the type of support that is necessary.

If a Mealtime Partner Dining System is going to be used, feel free to contact Mealtime Partners if you need assistance in establishing IEP goals for its use.

Whether it is eating or drinking Mealtime Partners has a HANDS-FREE solution to independence

The Mealtime Partner Dining System on Legs	The Front Mounted Drinking System
To maintain a healthy body, lots of fruits, vegetables and other nutritious foods should be consumed without the need to hurry the pace at which they are eaten. Additionally, plenty of water should be consumed, all day long. For those individuals who are unable to lift or hold a utensil or who are unable to pick up a cup, maintaining healthful consumption of liquids can be difficult. Mealtime Partners products provide a solution. For more information about our dining and drinking products please visit the Mealtime Partners website.
For more information about the most flexible assistive dining system available please visit: The Mealtime Partner Description, or call us at 800-996-8607. For information about all of our drinking products and for considerations for selecting the appropriate drinking system, click here.

Useful Equipment for Back to School

There are some items that can improve students function in school that are available from Mealtime Partners. Some are simple, and others more complicated.

It should be remembered that children who can’t help themselves to a drink of water while in school can easily become dehydrated. Mealtime Partners offers a variety of drinking systems, some of which provide hands-free access to a drink so that a teacher, teachers aid, etc., does not constantly have to provide liquids to the student. The following is a brief overview of some of the hands-free drinking systems we offer:

The Front Mounted Drinking System – this drinking system provides a cup holder that is mounted on a Flex Arm and the Flex Arm can be clamped to a wheelchair, bed rail or table top. It is available in 5 different Flex Arm lengths. It can accommodate a bottle of water with a straw in it, an insulated coffee mug with a straw in it, a can of soda with a straw in it, or a lidded cup with a straw. The straw can be positioned very near the mouth of the user to facilitate independent drinking without the need of hands.

The Hydration Backpack with Drinking Tube Positioning – This system is a modification of a hydration backpack that might be used by cyclists or other athletes. The tube from the backpack is enclosed in “flex tubing”. The flex tubing can be bent into almost any shape and will hold its shape until it is readjusted. It allows the drinking tube and the bite valve to be positioned close to the user’s mouth so that they can take a drink whenever they want. The flex tube is attached to the handle of a wheelchair and extends forward over the shoulder of the user and is curved to extend upward to the user’s mouth. It is designed to provide a large volume of water to a person who sits in a wheelchair for extended periods, like a student who is in school all day. It is suitable for individuals who have limited head movement and who have adequate oral control to bite and suck at the same time, which is how water is accessed through the bite valve. More information about this system can be found at our Drinking Products webpage.

The Drink-Aide Drinking System – The Drink-Aide Drinking System consists of an insulated water bottle that has flex tubing extending from the top of the bottle. The straw or drinking tube is contained in the flex tubing and thus can be positioned to be easily accessible to the user. The bottle is held in a cup holder that is clamped to the handle of a wheelchair. This system is suitable for those who have normal suction and who are able to pucker their lips around a firm drinking tube.

The Mealtime Partner Dining System – We cannot leave out our signature product! The Mealtime Partner Dining System is a powered dining system that allows individuals, who are unable to use their arms and/or hands, or use their fingers or a utensil, to eat independently. It can accommodate both normal table food that is cut into bite size pieces, or minced, or pureed food. Because of its capabilities and flexibility, the Mealtime Partner Dining System can serve the needs of children as young as 3 or 4 through adulthood. Much more information about this system can be found at Dining on Mealtime Partners Website, describing the device’s capabilities.

Mealtime Partners Cover-ups - Mealtime Partners Cover-ups are designed to protect clothing during meals. The company found that when people were learning to feed themselves, many have problems with food spillage. This is very typical of when someone is learning a new skill. When infants and young children begin self-feeding they are very messy; the same situation is experienced with older children and adults who have never experienced feeding themselves before. The difference between a little child and an adolescent, or an adult spilling food is that the older you are, the more self-conscious of spilling food you become. Additionally, many people are embarrassed by having their clothes soiled. Our Cover-ups were designed to avoid this situation and to make clean-up after meals easier. They have an outer surface of soft vinyl and are lined with flannel and have a pocket at the bottom edge to catch food that might have spilled. After meals the outer side of the cover-up can be wiped with a damp cloth, and it will be ready for the next meal. For more information on our Cover-Ups, click here.

Other products including switch mounts, clamps and other assistive mounting products can be found at: Mounting Products. If you would like to discuss any of these products and whether they are suitable for your students, please email or call us at: info@mealtimepartners.com / 800-996-8607. We are always pleased to assist you!

Did You Know? Did you know that 3-D printing is used in medicine as well as the manufacturing industry? Biomechanical engineers are using 3-D printers to create temporary teeth for the dental industry, custom hearing aids that fit exactly to the individual’s ear, and researchers are developing the technology to use 3-D printing to “grow” organs. Currently, simple structures that have man-made scaffolding that adheres to an individual’s own tissue cells are being created and implanted into patients. Such items as trachea and urethra have been made with 3-D printing technology and implanted, and their success is being tracked. Larger clinical trials must take place prior to this type of tissue replacement becoming common place. In the meantime, the University of Florida is transferring x-ray, MRI, and CT scans of individual’s heads into a 3-D printer to create an exact replica of their skull and brain. This allows neurosurgery students to practice operating on realistic skulls without the risk to a patient of having a novice surgeon operate on their brain. It is anticipated that within the next 20 years, this technology will be used throughout the medical industry and revolutionize the state of organ transplants.

Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

August 2014 Independent Eating and Drinking Newsletter

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