Mealtime Partners, Inc.


Specializing in Assistive Dining Equipment and Accessories

January 2010 Newsletter

Independent Eating...   is a Wonderful Thing 

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Stimulus Funds Available for Assistive Technology Equipment for Schools

The purpose of this Newsletter article is to help schools understand how stimulus funding can significantly aid their students with special needs in meeting their Individualized Education Program (IEP) Goals by gaining the functional ability to be able to eat independently. With a one-time investment in assistive technology, available through the use of stimulus funds, students will gain immediate benefits that will last throughout their school career and prepare them for life-long independence in a very significant functional skill.

As many readers are aware, the American Recovery and Reinvestment Act of 2009 (ARRA) has allocated significant economic stimulus funding for programs under Part B and C of the Individuals with Disabilities Education Act (IDEA). Part B of IDEA funds educational agencies to ensure that children with disabilities have access to a free appropriate public education to meet each child’s unique needs and prepare him or her for further education, employment, and independent living. $11.3 billion of stimulus funding has been made available for Part B support (American Recovery and Reinvestment Act of 2009: IDEA Recovery Funds for Services to Children and Youths with Disabilities).

In general, the stimulus funds are to be used for short-term investments that have the potential for long-term benefits. One of the primary purposes for these funds is to “obtain state-of-the-art assistive technology (AT) devices and provide training in their use to enhance access to the general curriculum for students with disabilities.” This is indeed a rare opportunity to provide substantial aid to students who are most in need of that support. It should be noted that all ARRA funds must be used consistent with the current IDEA, Part B statutory and regulatory requirements (IDEA 2004 Subpart B: State Eligibility). Assistive technology is defined by IDEA as: “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. The term does not include a medical device that is surgically implanted or the replacement of such devices” (20 U.S.C. 1221e-3, 1406, 1411-1419). The American Heritage Dictionary defines state-of-the-art as: the highest level of development, as of a device, technique, or science field, achieved at a particular time.

Eating is an all-important part of a student’s life and their school day. Not only is the food essential to sustain them and allow them to work well (mentally and physically), but additionally, breakfast and lunchtimes at school are wonderful opportunities for developing functional and social skills. For those students who cannot self-feed, independent eating should certainly be one of their IEP goals. For most students who cannot self-feed by school age, achieving that goal will need to include some type of assistive technology when the IEP goal is developed. (For more information about IEP Goals for independent eating, the Mealtime Partners August 2009 and September 2009 Newsletters discuss this topic in some detail.)

The value of gaining the ability to feed oneself should not be overlooked or underestimated as it can contribute significantly to the student’s functional, emotional and academic development. Also, current clinical research has established that people who are fed have a far higher risk of aspiration than those who self-feeding (Reference1).  Independent eating is therefore a safety issue, also.

It might be questioned as to how gaining the ability to feed ones-self helps with academic development. But it should be understood that eating independently using assistive technology naturally develops many of the prerequisite skill for early learning such as: an understanding of cause and effect, choice making, and self-regulation. Additionally, the use of AT to eat can provide the routine practice necessary for a student to develop mastery of adaptive switch use. Students are motivated to activate switches over and over because they receive a bite of food for each successful switch-hit. Food can be a powerful motivator and can be used as a tool for teaching. This leads to students developing the necessary skills to be able to access computer software or a communication device, and to achieve functional control in many other areas (and to achieve other IEP goals).

Emotionally, a student’s self-perception is rapidly changed when they are able to accomplish such a significant goal as being able to self-feed. They move from a self-concept of being dependent to a new view of themselves as being able to do something on their own. It is not unusual to have young students exhibit extreme surprise at their own abilities once they are provided with AT to empower them. For further information about the importance of independent eating for children see the August 2009 Mealtime Partners Newsletter. However, independent eating is a very complex activity of daily living. Not only does a student who lacks self-feeding skills have to develop muscle control over a wide range of muscles that must interplay to make independent eating possible, but they must contend with the wide variety of food consistencies and textures that complicate eating further. In other words, it may require some time to teach eating skills to a child who is school age and hasn’t yet developed them. It is the obligation of the school to teach them to eat independently, if at all possible, to increase their functionality to the greatest extent possible and to ready them for independent living.

Currently, equipment that supports mealtime independence for those who are unable to self-feed can be broken down into four main categories: 1) adapted utensils and dishes, 2) non-powered dining equipment, 3) arm supports, and 4) powered dining equipment. However, powered dining devices are the only assistive technology that can facilitate independent eating for individuals with extremely limited or no arm and hand capabilities.

One of the major concerns expressed by school staff when complex assistive technology is needed to fulfill a student’s IEP goals is that the budget is not available to provide the equipment. However, with the current availability of stimulus funding for schools, now is the best time to consider providing advanced technology to those students who will benefit from it. For many students, gaining mealtime independence is an attainable functional goal that will serve them for the rest of their lives, and will provide them the first real experience of independence that they will have ever known. Complete information about obtaining stimulus funds for assistive technology can be found at your state education department website. For help, contact your Local Education Agency.

To further stretch the American Recovery and Reinvestment Act of 2009 (ARRA) funds Mealtime Partners, Inc. will provide a discount off of the retail price for all equipment purchased with ARRA funds in 2010. Just let us know that the ARRA funding is being used. (For further details about the ARRA discount, call Mealtime Partners Inc. at 800-996-8607, or 817-237-991 in Texas.) These funds are limited and will not last long. Update your special children’s IEP and submit funding applications as soon as possible. 

Mealtime Partner being used by Child The Mealtime Partner is so flexible 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, regardless of their diverse eating needs. For more information about the Mealtime Partner Dining System, you can visit the Mealtime Partners website, or view our 4 minute video.



Food Flavor

Our awareness of the flavor of food is a combination of the smell and taste of the food. The enjoyment of food is significantly impacted by the individual perception of its flavor. Some people do not consume an adequate amount of nutrition because they aren’t interested in the food they are served. By adding flavor to the food they eat, they potentially will be more motivated to eat, and are less likely to be undernourished (or malnourished).

The roof of our mouth and tongue are covered with thousands of taste buds that provide us with our sense of taste. When we eat, the taste buds send messages, through sensory nerves, to the brain and thus we are aware of different flavors. Different parts of the tongue sense different flavors. Salty and sweet flavors are sensed near the front or the tip of the tongue. The sides of the tongue sense sour flavors and the back of the tongue senses bitter.

Our sense of taste changes as we age. Infants and young children are very aware of flavor. As we grow, we loose taste buds and as we get older, our taste buds become less sensitive. Additionally, medications, medical conditions, smoking, chemical and radiation exposure, can cause taste disorders or loss. Some children who have disabilities lack the normal sensation for flavor from birth. For them, strong flavors are important to facilitate their ability to track where food is in their mouth.

The flavor of food is important to its enjoyment. If you have reduced sensitivity to taste, stronger flavor is necessary to be aware of food having any flavor. Individuals do not appreciate subtle flavors if they have reduced sensitivity of their taste buds. One of the byproducts of loss of taste is loss of desire to eat. This puts individuals at a risk of undernutrition or even, over time, malnutrition. Additionally, if meats are minced or pureed for those who are at risk of choking or aspiration, they loose most of there flavor and are thus, undesirable. When this occurs the individual can potentially develop Kwoshiorkor2, a form of malnutrition.

Most people do not enjoy a diet that consists only of bland foods (except, sometimes, when they are ill). Many add salt and pepper or various sauces (barbeque, ketchup, Tabasco, etc.). As people age and the sensitivity of their taste buds reduces, food appears to lose its flavor. But the food isn’t really losing its flavor; the person is losing their flavor sensation. You often hear people comment that food just doesn’t taste like is used to. Unfortunately, as we age, our stomachs become older too and are less tolerant of what we eat. This is a Catch-22 situation; we taste less but we get an upset stomach more easily from the flavor additives. Additionally, many people have to watch how much fat, sugar, and salt that they eat. Again, the availability of flavor is reduced.

There are many ways to help supplement flavors without compromising health. First let us discuss children who have reduced awareness of flavor due to illness or disabilities . For them, often texture in the food that is being offered helps them “feel” the food in their mouth, rather than actually tasting it. For example, a little breakfast cereal (e.g., crunched up Rice Crispies) in yogurt can make it easier to control the food inside the mouth. Also, many children enjoy “hot” flavors. Frito-LayTM makes Cheeto’s® Flamin’ Hot chips that are easy to chew and have enough “kick” to them that they can be felt when they are put in the mouth. They are very popular with children who have limited taste capacity. They can both taste and feel them. Ethnic foods like pizza or enchiladas, or adding hot sauce to other foods, provide a strong enough flavor for them to be tasted even with reduced taste bud sensation.

For older people spicy food is frequently an unsuitable solution to lack of taste sensation because spicy foods tend to cause acid reflux and indigestion, as mentioned previously. For those whose stomachs cannot tolerate highly flavored foods, blander foods can have their flavor enhanced. Adding salt substitute or salt free seasonings can increase flavor. Pepper is not recommended for those who have a delicate stomach as it can be an irritant to the stomach. Additionally, sweetening foods can enhance their taste. For those who must watch their calorie intake, Splenda®, or many of the other sugar substitutes can be used. Note that some people require a large volume of sweetener to be added before they become aware of the additional flavor.

Temperature can also make food taste different. The flavor of some foods is enhanced by it being chilled while other foods are unpleasant if they are not served hot. (In Nursing homes a common complaint is that the food gets cold while the residents are waiting to be fed.)

In summary, enhancing the flavor of foods for those whose taste buds are insensitive, allows meals to be more enjoyable. This greatly increases the pleasure in eating, and people who are under nourished will potentially eat more, thus easing their nutrition related problems. Being empowered to feed ones self also allows meals to be more enjoyable. When you can choose when to take a bite of food and what food you will eat or not eat, the pleasure and dignity associated with mealtimes is improved. The Mealtime Partner Dining System can serve a wide variety of different table foods as well as texture controlled diets and can empowered the consumer to control the flow of their own dining or mealtime experience.

 

Due to the great importance of proper hydration, Mealtime Partners recommends that everyone be provided the means to drink at any time they wish. For most individuals, dehydration is 100% preventable. And yet many people with disabilities suffer from some level of dehydration almost constantly. 

Mealtime Partners, Inc. provides a variety of drinking systems that can meet the needs of most individuals. Most of these systems can be mounted on a wheelchair, or bed. To learn about the Mealtime Partners drinking systems, click here. Information is available to help you select the right drinking system. And, if you still have questions about selecting a drinking system, please call please call us at 800-996-8607. We will be pleased to assist you.


January 2010 Newsletter References:

1. DeLegge, M. H., Aspiration pneumonia: Incidence, mortality, and at-risk populations. Journal of Parenteral and Enteral Nutrition, Nov/Dec, 2002.

2. Kwoshiorkor is a form of malnutrition that occurs when there is not enough protein in the diet. Kwashiorkor is common in areas where there is: famine, limited food supply, or low levels of education (when people do not understand how to eat a proper diet). Kwashiorkor is very rare in children in the U.S. However, one government estimate suggests that as many as 50% of elderly people in nursing homes in the U.S. do not get enough protein in their diet. (Medline Plus, U.S. National Library of Medicine and the National Institutes of Health.)

 


 

 

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