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Mealtime Partners, Inc. (MtP) September 2009 Newsletter

Independent Eating... is a Wonderful Thing

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IEP Goals for Independent Eating (Part 2)

In the August 2009 Newsletter, we discussed IEP goals relating to eating for students whose educational needs are being met through special education programs: IEP Goals for Independent Eating (Part 1). In this month’s Newsletter we continue the discussion of IEP goals relating to eating by discussing the needs of students who attend regular classes but who are unable to self-feed.

It is essential that students receive adequate nutrition to be able to perform at their best in school. Mealtimes are a very important part of the school day (both socially and nutritionally) because many children eat both breakfast and lunch at school. However, children who cannot self-feed are treated differently from the mainstream student body. They spend their mealtimes with an adult. This might be a teacher’s aide, or a teacher, but the student does not sit and interact with other students in the same manner as their non-disabled peers. The physical presence of an adult in the immediate vicinity alters the dynamics of the experience. For a student whose educational needs are being met in mainstream classes, this can be a stigmatizing experience. It immediately inhibits the free flow of social interactions between other students.

It is not uncommon to find that as mainstreamed students with disabilities become teenagers they become reluctant to eat meals at school because of the stigma attached to being fed. They use all sorts of excuses about not being hungry or having had breakfast at home, etc. Alternately, they will choose to have liquid nutrition (Ensure, or a similar product) that they can drink out of the can using a straw that does not make it obvious that they cannot self-feed. Teachers and aides, in an attempt to help the student overcome their embarrassment, will arrange for them to eat in the classroom. This allows the student to eat in private but removes them from the experience of eating with their peers. It is a “Catch 22” situation. Many disabled students end up eating with a group of other disabled students in the cafeteria. They are, by default, isolated from their non-disabled peers, which is specifically what the Individuals with Disabilities Education Act (IDEA) intended to avoid. 

For this group of students, IEP goals should include normalizing, nonacademic experiences for them. For them, assistive technology (AT) can be a gateway to functioning independently in this setting. Students who use wheelchairs to meet their mobility needs are often deprived of the opportunity of eating with their peers by something as simple as the height of the school cafeteria table. Many powered wheelchairs are so tall that the arms of the chair prohibit it’s occupant from getting close enough to the cafeteria table to be able to eat comfortably. Without much difficulty this situation can be overcome by placing a computer table, that is height adjustable, at the end of an existing cafeteria table. The student can still sit with their classmates and can get close enough to the table to eat. In this situation, the computer table should be included as an AT requirement in their IEP documentation. 

This strategy can also be used to facilitate additional independent eating needs. For students who have limited arm movement, the computer table height can be raised enough to make it easier for the student to lift food from the table surface to their mouth. This approach is beneficial for students who have degenerative conditions such as Duchenne’s muscular dystrophy. For them, using a computer table allows adjustments to be made to accommodate their changing needs without changing the “look” of their mealtime situation. 

Adaptive utensils, dishes and dining devices (both manual and powered) should also be included as AT requirements in an IEP. The IEP goal should be to provide the student the means to be as independent as possible in an activity of daily living. This is a functional skill that will, once mastered, support them for the rest of their lives, and acquiring it prepares them for further education, employment, and independent living. 

In many cases, school staff rationalize that a student has assistance from a classroom aide during classes and that it is therefore logical that the aide simply continue supporting the student by feeding them meals. However, this philosophy neither meets the intent of IDEA nor gives the student the opportunity to become more self-sufficient. The goal should always be to facilitate the student becoming as independent as possible.

Measurable IEP goals that relate to independent eating should include a description of the problem: Janet is unable to self-feed. The current level of performance: she is neither able to finger feed or feed herself with a utensil, or (in the case of a student with a degenerative condition), Janet can no longer finger feed or use a utensil to feed herself. The level of change that is anticipated by the end of this IEP year: Janet will feed herself 10 bites of food independently at each meal. How this will be accomplished: Janet will be provided with a Mealtime Partner dining system that she will control using adaptive switches, which will allow her to feed herself.

Additionally, how the student’s progress will be measured during the year should be documented. In the case given above, Janet’s progress can be measured by her success rate at activating an adaptive switch, or, her ability to take food from the spoon without prompting, the number of bites of food she takes independently, etc.

We’ve included our primary product’s name in the above example because it is the most capable device of that type on the market. Needless to say, you would select the least expensive assistive product that would enable the student to accomplish the IEP goals set forth. For some, a tremor damping device, a special spoon, or even a special chair with appropriate positioning support may be all that is needed for them to eat independently.

For the mainstreamed student who cannot self-feed, using a Mealtime Partner Dining System to assist him/her in eating can help them to continue to develop fundamental eating skills and to achieve their IEP goals for independent eating. The Mealtime Partner can easily be used in a school cafeteria. It is light weight and battery operated, requiring no external electrical connections during use. The versatile mounting systems that are available will easily accommodate any cafeteria table and wheelchair arrangement. With very little setup time, a normal mealtime social setting can be established so that the user can eat with their peers.

Selecting Best Times to Teach New Eating Methods

The time of day that new procedures for eating are taught is important to the success of the training. Because timing significantly impacts the results achieved, we offer the following recommendations. Actually, it is not so much the time of day that is important, it is the hunger level of the person being trained, and, the person’s level of fatigue. Hunger can be predicted because meals usually occur at certain times during the day. Fatigue, however, is more difficult to predict as it correlates with the activities conducted prior to the training session and, in many cases, the health of the person, or even how well they slept the previous night.

Our experience has revealed that the majority of clinicians and caregivers believe that the best time to teach someone to become an independent eater is at mealtimes. Their reasoning tells them that when the person is hungry they will be more interested in learning how to feed themselves. However, most often, the worst time to try to teach self-feeding skills is when someone is hungry. When hungry you are driven by a need to eat, to be distracted from eating by being instructed is, at times, frustrating and/or annoying because it interrupts the intake of food. Under these circumstances, the person being trained will not necessarily pay good attention to the guidance they are receiving. Their instructor is concerned with providing direction, and at times will need to move slowly through their instructions. This interrupts the consumption of the meal. The delay in getting food will be very frustrating to someone who is hungry and they will become impatient with the lesson because they want to eat.

The best time to instruct someone in self-feeding skills is after a meal. For example, at lunch-time, the dessert can be used for teaching purposes. The person being instructed, having mostly satiated their appetite with the main course will be better able to pay attention to instructions. Additionally, the dessert is normally viewed as a treat and is therefore an incentive for executing instructions. Mid-mornings and mid-afternoons, i.e., anytime before the full hunger level returns are also good times to teach new eating procedures.

Instructional sessions should be limited to a maximum of 30 minutes. The majority of people who are learning to feed themselves, fatigue rapidly compared with their able-bodied peers. It is always advisable to watch for a decline in reliability of arm/hand and head movements as an indicator that the training session should end. Taking just a few bites of food for many people learning to gain mealtime independence, can be strenuous and exhaust them. They are learning to coordinate muscles that they have never coordinated before. It will take time for the muscles to develop and for them to be able to sustain repetitive use without fatigue. This is true of both the muscles being used to provide food to their mouth, stabilize their head, and, in some cases their oral motor muscles. It must be remembered that when someone has always been fed, their feeding partner does much, or all, of the work of getting food into the person’s mouth and off of the utensil, therefore gaining independence at mealtimes is a completely new experience and will take time to learn.

Providing food that is a treat for the individual receiving training can produce additional motivation. In many cases when the food is very appealing the person will enjoy working hard during a training session.

In many cases clients will need to evaluate dining equipment and clinicians will request that vendors provide equipment for this purpose. It should be remembered by clinicians and vendors, including Mealtime Partners Dealers and Representatives, that the advice provided above strongly applies to the first time the person is exposed to this type of training which often occurs during the initial product evaluation.

A MtP Tip: Strongly flavored foods and salty foods are sometimes more popular than sweet treats.

September 2009 Newsletter References:

1. Individuals with Disabilities Education Act (IDEA). Code of Federal Regulations (CFR), Volume 34, Part 300



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