Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

November 2011 Independent Eating and Drinking Newsletter

Independent Eating...   is a Wonderful Thing

November Topics:

  • Jane's Unexpected Consequence
  • John's Unexpected Consequence
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Unintended consequences are usually associated with a negative result in something that is intended to do something good. For example, a law intended to aid a certain group of individuals that turns out to affect them (or another group) in a negative way; or, a new wonder drug that has a very negative, unexpected side effect, etc. However, sometimes an unintended consequence turns out to be very beneficial.

The predecessor of the Mealtime Partner Dining System, the Assistive Dining Device (ADD), was conceived at the Arc of the United States. The Arc is an advocacy organization that works to improve the lives of people who have intellectual and developmental disabilities ( The Arc identified that there is a higher percentage of people who are unable to feed themselves who have intellectual disabilities than compared with the general population. With intellectual access as well as easy physical access a significant component of the design concept, the ADD was developed. This design later evolved into the Mealtime Partner Dining System which is functionally identical but weighs less and is more compact.

These devices, the original ADD and the Mealtime Partner, were developed to aid individuals with intellectual and physical disabilities to feed themselves; it is intended to provide them the opportunity for greater independence at meal and snack times. However, for individuals who have developmental delays, the device also provides a rich learning experience. There are often other unintended or unexpected benefits resulting from its use. The following vignettes are based on our observations and communications with the participants, and illustrate this point. (Of course, the names have been changed to protect their privacy).

Jane's Unexpected Consequence

This is a story about Jane who was fifteen years old when she first started using the Mealtime Partners Dining System. She has cerebral palsy, is non-ambulatory and has unintelligible speech, except to those who know her well. She was in a life skills class at a public high school. She has a powered wheelchair that is controlled by a head array. However, she is unable to drive her wheelchair using left and/or right. Instead she simply goes forward in a straight line. Therefore, most of the time a teacher, or aide, control the chair for her. She had previously used adaptive switches for group activities in the classroom but did not use them on a day-to-day basis.

When she received her Mealtime Partner Dining System the two adaptive switches for its control were mounted on her wheelchair. They extended forward beyond the wheelchair head support and she pressed them using the left and right front of her temple. This action stimulated her forward and down head movement, placing her head in a position that produced a chin tuck. (For more information about a chin tuck, refer to an earlier Newsletter, Promoting a Chin Tuck for Safer Eating.) At first, Jane did not associate pressing a switch with receiving a spoonful of food. Staff who were working with her on learning to feed herself provided verbal prompts to help her associate the two functions: “Jane press the switch and get a bite”, etc. At first the prompts were extensive but as Jane demonstrated her understanding of being in control of each bite of food that she received, the prompts were faded and in time discontinued.

For the first two months that she worked with her Mealtime Partner, Jane had one food selection at each session. She only used the adaptive switch that activated the spoon, even though the second switch that activated bowl movement was mounted on her switch mount. It was moved slightly out of reach of her head. This allowed her to be aware of the second switch but would not be distracted by it. Once Jane demonstrated that she fully understood cause and effect (pressing the switch provided her with a single spoonful of food, and repeating the process gave her another bite of food, etc.), the second switch was introduced into her training program.

Because Jane now clearly understood the cause and effect that was provided through the use of the first switch, she was next shown how choice making was provided by the second switch. This was learned more quickly. Verbal prompting was once again used. However, very rapidly Jane demonstrated that she understood that to get food that she identified as “good” required her to press the second switch to make the food “come to her”. Once the food that she wanted to eat was within her line of sight, she activated the spoon switch and received a bite of the food that she had chosen. It was obvious that she was making choices as she would skip bowls containing food that she didn’t like as much, e.g., green beans. Additionally, Jane revealed strong preferences in how she likes to eat. She would eat a bite of salty food (popcorn, pretzels or potato chips) and then take a bite of a sweeter food (fruit, pudding, or Jell-O).

After approximately 4 months of training and practice, Jane began to eat all of her meals at school with the Mealtime Partner. She was extremely proud of her accomplishment and took great pleasure in demonstrating how she ate using the device, if anyone asked about it. Despite many prior efforts to empower Jane through the use of assistive technology (AT), the Mealtime Partner was her first experience with AT that both motivated her to practice enough to become a competent adaptive switch user and provide her a graphic illustration of cause and effect and choice making.

The unexpected consequence of Jane’s experience with the Mealtime Partner occurred six months after she was first introduced to the Mealtime Partner. The Assistive Technology (AT) team for her school evaluated her for computer use. During the evaluation Jane did not respond to any of the attempts made by the team. Finally, her teacher suggested using her “eating switches” for computer access, rather than the switches being presented to Jane by the AT team. Once the switches were hooked up to the computer and some verbal prompts were provided, Jane began to use the computer in her classroom. She transferred the understanding she had gained from controlling the Mealtime Partner to controlling a computer, providing her the benefit of a second skill.

When Jane’s sixteenth birthday took place she insisted that family and friends come to school to share in the celebration and with great pride she ate her birthday cake for the first time without being fed!


Did You Know? Did you know that the Center for Medicare and Medicaid Services (CMS) are evaluating how the word “durable” should be defined within the concept of “durable medical equipment”. How long should something last to be counted as durable? The Federal Register/Vol.76, No. 218/Page 70285 discusses how long equipment should function in order to be considered “durable”. CMS is considering adding a minimum life requirement (MLR) of 3 years to be required for equipment to qualify as durable medical equipment. The 3 year MLR when implemented is anticipated to be prospective and will not be applied on a retroactive basis. A final decision should be made this month.

John's Unexpected Consequence

John is an 8 year old boy with a diagnosis of cerebral palsy and low vision. He is non-ambulatory and until he was approximately six years old he received all of his hydration and nutrition via a gastric feeding tube (or, g-tube). Since being introduced to oral drinking and eating, John has mastered eating texture controlled foods. He gags if there are too many lumps in the food but is able to process small lumps and derives great pleasure from eating orally. He has also learned to drink using a straw without crushing the straw with his teeth. Because of John’s low muscle tone he has been fed in a slightly reclining position to prevent gravity from tipping his head forward onto his chest.

Prior to receiving his Mealtime Partner Dining System, John received a new wheelchair as he had outgrown his old chair. The new chair has many features not present on his prior chair including a head-rest with lateral supports. John’s family and therapists decided that John should begin to sit in his new wheelchair to eat as it provided him with excellent support. The chair has a tilt function on it and was positioned with a slight backward tilt during eating.

When John first starting learning to use the Mealtime Partner he did not understand the concept of eating; he just understood the concept of being fed. He expected the spoon to be put into his mouth and the food removed from the spoon for him. With the motivation of favorite foods and hunger, John quite rapidly learned to move towards the spoon and take it into his mouth. Because of the slight recline of his wheelchair this movement was an upward, rather than forward, head movement. He also had difficulty with closing his lips over the spoon (another concept that was new to him), but with physical assistance lowering his upper lip, he began to understand the concept and his desire for the food being offered, encouraged him to work at lip control.

After a few days, John demonstrated his understanding of the Mealtime Partner operation patterns. With verbal prompting, he would depress the adaptive switch that controlled the spoon movement. Because he has low vision, he used the small amount of noise from the Mealtime Partner when the spoon extends as a queue for taking the food. Thus, when the Mealtime Partner became silent after he had pressed the switch, he took the spoon into his mouth, closed his lips and took the food off of the spoon.

As John adjusted to his new wheelchair seating system, modifications to his mealtime positioning were made and gradually he was placed in an almost upright position. A small pillow was placed around his shoulders and neck to provide additional head support and John began to eat using the Mealtime Partner without difficulties. He showed that he was fully aware of the sounds produced by the device and understood when it was offering him a bite of food. He approached the first bite at any meal with caution to make sure it was food that he liked and then ate with enthusiasm.

The surprising unexpected/unforeseen consequence that resulted from John eating independently was the remarkable improvement of his head control. After a few mouths of eating using his Mealtime Partner, John is able to lift his head forward, away from his head support, maintain control of his head long enough to take food off of the spoon, and return it to his head rest in a controlled manner. He now has control over muscles in his neck that were previously not being used.


For all of our current ADD and Mealtime Partner customers, please share your unintended consequences with us. To send us your story, click here.


Mealtime Partner Serving Peas             Pass the Peas Please

Peas aren't the easiest things to pick up, but the Mealtime Partner can reliably serve bite after bite of them if that’s what you want. If not, just move on to the next bowl and sample the pasta salad.

The Mealtime Partner empowers its user to eat
what they want, when they want it.

To see a video of the Mealtime Partner Dining System, click here. To discuss how it might meet your specific needs, call us at 800-996-8607 or email us by clicking here. (Be sure to include your telephone number so we can give you a call.)

The Mealtime Partner Dining System is quick and easy to learn and has no complicated programming requirements. Each Dining System comes with a complete training video on DVD so new users and caregivers can learn to use it in just a few minutes. To view a list of the instructional videos that may be selected by title, click here.

The Mealtime Partner is by far the best assistive dining equipment ever developed. Before the engineering design team ever started, the design requirements for it were developed by a team of medical experts working with potential users. They examined the shortcomings in prior designs, the needs and desires of users, and the special requirements for providing safe and reliable operation in the various, often harsh, environmental settings where it must function. This resulted in the design of a dining system with quiet operation, that is easy to setup and use, easy to clean, has high durability (will last many years), serves food reliably, and is very safe to use. There are no other devices currently on the market that can even come close to matching its performance. For more information about the Mealtime Partner, click here.

The Mealtime Partner meets the Medicare and Medicaid definitions of Durable Medical Equipment (DME). The United States Food and Drug Administration (FDA) considers the Mealtime Partner to be a Class I type medical device. The Mealtime Partners has successfully completed all governmental electrical safety and electro-magnetic compatibility (EMC) compliance testing. For more information about safety testing, click here.

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