Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

September 2011 Independent Eating and Drinking Newsletter

Independent Eating...   is a Wonderful Thing

September Topics:

  • Positioning Equipment for Individuals with Disabilities
  • Caring for the Caregiver
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Positioning Equipment for Individuals with Disabilities

There are several aspects about “positioning” that contribute to positive outcomes for individuals who have severe disabilities. Having the person’s body in the correct position to undertake a task, is one. The right location for equipment, relative to the individual using it, is another. Having a wheelchair provide good support and positioning for its occupant is also important to being able to successfully undertake and complete a task, especially when using assistive equipment.

This article will discuss the considerations of positioning and maintaining the position of assistive technology (i.e., equipment for assisting individuals with disabilities) for it to be used over an extended time without the person using it being unnecessarily stressed. As a caveat to this discussion, it should be noted that equipment positioning, in most cases, does not simply require it to be put in place. It also requires that it can be removed, or relocated out-of-the-way, quickly and easily. This additional need for rapid repositioning complicates mounting and positioning equipment dramatically.

Equipment that requires positioning for undertaking various activities of daily living (ADLs) include controls for powered wheelchairs, that provide independent mobility for the user; communication devices that allow their user to express their wants and needs as well as providing a way of having a conversation; adaptive switches that provide control over a wide range of things, like turning lights on or off, etc.; and eating and drinking equipment.

To position any equipment to meet the needs of its user, their abilities, or lack of ability must be considered. To make the best selection the person’s volitional movement should be considered (i.e., their ability to perform or abstain from performing an action at their own will). Their muscle strength and endurance, their muscle tone and any reflexive movements that might be present, their range of motion, and how quickly they fatigue must all be factored into making the correct equipment positioning decision.

Powered wheelchair controls are available in many different forms. It is important to select the controls that best meet the needs of the user. A joystick is the most common control for a wheelchair and is typically operated by the user’s hand. However, joysticks can also be operated with a foot or chin. Regardless of whether a hand, foot or chin is being used, the positioning of the joystick makes the difference between easy operation of the wheelchair, and stressful and/or tiring operation. If a joystick is not appropriate because of an individual’s limitations, head controls (a series of switches mounted in the headrest of the wheelchair), or a Sip N Puff (that activates using a suck or blow on a tube that is positioned very close to the user’s mouth) can be considered. Head, and Sip N Puff controls, are normally used by individuals who have very limited control of their extremities, but who have relatively good head control. Regardless of the type of wheelchair control that is selected, the positioning of the controls is especially important for those who have very limited range of motion and poor muscle tone. Rarely, do wheelchair controls become displaced because wheelchair manufacturers have refined mounting controls over the past 40 years and now have excellent methods for mounting and moving controls. Therefore, as long as the correct choices are made when a wheelchair is being ordered, the controls should maintain their positioning throughout the lifetime of the wheelchair.

Head Array Switches Sip N Puff Wheelchair Controls
Head Array Wheelchair Controls Sip N Puff Wheelchair Controls

Augmentative and alternative communication devices (AAC) are another category of products that require device positioning to be accurate for user access. The considerations that should be well thought through when an AAC device is being set up is where the device will be located: on a table, on a wheelchair, on a bed, or freestanding. Next, how the device will be accessed should be decided: direct device interface (touching the device to make it operate); using an adaptive switch; eye gaze, or some other method. Lastly, whether the device will need to be moved in and out of position should be determined. This normally only occurs if the device is mounted on a wheelchair. In that case it will need to be moved when the user goes to the restroom, or, in most cases, eats, or gets out of their wheelchair for any other reason. If the device is on a table, the user can move in and out of position as necessary rather than the device being moved.

Freestanding device mounting is used for both those who are in a wheelchair and people who use the device while in bed. Many users transition from wheelchair to bed and still want to be able to access their device, most freestanding device mounts will allow the angle at which the device is positioned to be easily adjusted for the changing circumstances. If an AAC device is being accessed using an adaptive switch, the switch location and position and how it will be mounted will need to be determined. Positioning for eye gaze access to a communication device requires the most precise device positioning, but as eye gaze technology gets better and better the necessity for precise user positioning decreases.

Mealtime Partners, Inc. ongoingly promotes hydration systems being made available to people who are unable to drink independently using their hands to hold a cup. Positioning a drinking system, for those individuals who have very limited range of motion is very important. The position of a drinking tube is important for the user to access it but it must also be positioned to facilitate safe drinking and swallowing. To meet that requirement, drinking systems are either held on a flexible arm that, once positioned, hold their position firmly, or by using flexible conduit as a guide for the drinking tube. Just like the flexible arm, once positioned, it holds its location.

Also, because of the great importance of positioning assistive equipment, the Mealtime Partner Dining System can be mounted using three different mounting and positioning systems. The Support Arm and Mounting Shafts are both attached to a table-top using the Table Clamp. The Clamp was designed to address the need to attach it to varying thicknesses of table surfaces. (It can accommodate table thicknesses up to 3 ¼".) Its unique socket accommodates either the Support Arm or Mounting Shafts, and once it is inserted into the clamp it can be locked into the socket to prohibit removal while the equipment is being used, yet is able to rotate out of the way if needed. Both of these mounting systems allow the Mealtime Partner Dining Device to be positioned at the optimal position for each individual user. Using the Support Arm allows the device to be positioned to facilitate the spoon serving food extremely close to the user’s mouth. This position can be (and should be) adjusted to accommodate a chin tuck to enhance the safety of eating.

Recently, Mealtime Partners, Inc. introduced a Hospital Bed Clamp System and a Hospital Bed Hydration System both of which allow equipment to be mounted and positioned for reliable and easy access for patients who have limited ability to move and who are restricted to a hospital bed. These products were developed by Mealtime Partners because of the great importance of providing those who have limited access to a call button or a drink to be able to undertake these tasks independently, and because previously available clamping methods were unable to be attached securely to many of the modern hospital beds now being used. Without a firm, secure attachment to the bed, equipment will move away from the user and become inaccessible to them. 

For information about all of the Mealtime Partners Drinking Systems, click here, or call 800.996.8607.

Did You Know? Did you know that a fork can be used to decide how thick liquids are? If the tines of a fork are dipped into thin liquid the liquid will simply run through them and there will be little or no coating left on the prongs. If the same test is used for slightly thickened liquid (described as nectar thick) the liquid will pass through the tines but will leave a coat on them. For honey thick liquid, the liquid will coat the fork and slowly sink through the tines. Extremely thick liquids (pudding thick) will remain on the tines of the fork and hold together. (Reference: The Australian standardized definitions and terminology for texture-modified foods and fluids, Nutrition and Dietetics, 2007: 64, Suppl. 2.)

Caring for the Caregiver

When the Mealtime Partner Dining System was in its infancy, analysis was done on the time spent providing mealtime assistance by caregivers, (or as we choose to describe them, mealtime partners) because an assistive dining system has great potential to alleviate caregiver burden. Feeding someone three meals each day, seven days a week, turns out to be extremely time consuming. If each meal takes 20 minutes, at least an hour a day is spent feeding the care recipient. For many people with oral motor difficulties, the time for them to have their meal can be two, or even three times longer. The result is that the person being fed is often hurried, and/or does not receive all of the calories that they should at a meal.

The US Census Bureau estimated in 2005 that 4.7 % of the U.S. adult population needed help completing one or more activities of daily living. In many cases this assistance is provided by a family member rather than a paid care provider. According to the Family Caregiver Alliance “Caregiving in the U.S. 2009” report, an estimated 65.7 million people have served as unpaid care providers to an adult or child within the last twelve months. Of those caregivers 74% were concurrently employed, and of that 74%, 68% must make special workplace accommodations due to their caregiving. The value of the caregiving services provided by unpaid caregivers was estimated to be $375 billion.

With the large number of people providing care to others in the U.S., the health of these people must also be considered. Research shows that not only does caregiving have deleterious mental health effects, including depression, but it can also have serious physical health consequences.

Therefore, the burden of care undertaken and its impact upon the person providing it should be considered, and the long term consequences evaluated. If you are a care provider, or know someone who is, make sure that you, or they, take care of themselves because if they don’t, their care recipient may have no one to look after them and will require a more formal type of institutional care such as assisted living or a nursing home.

A practical way of lessening the burden for a caregiver is through the use of assistive technology. Using a lift to move the person into or out of bed and/or to take them to the bathroom significantly reduces the physical effort expended by the caregiver to complete these tasks. A hospital bed that has electric controls can make moving the person easier or allow them to move themselves. A light-weight transport chair can be used for movement within the home, once again reducing the physical demand upon the caregiver. Transport chairs are typically small enough to be able to move throughout standard homes (homes not built or remodeled to be accessible). Drinking systems can be mounted on wheelchairs and/or beds to alleviate the need to provide regular sips of liquid. And, of course, an assistive dining device like the Mealtime Partner can greatly reduce the time required for the most time consuming caregiver activity, feeding their care recipient every spoonful of food they will receive. Many of these items can be provided through health insurance.

On a more personal level, the caregiver can (and should) receive an occasional short break by using day care facilities, or having friends, or family members come and help them. This also will allow them go to the store, or get their hair cut, or even give them a chance to go to a movie or the gym. Many individuals do not feel that they can ask for help and therefore they tend to “go it alone” as far as providing care is concerned. However, many people would be happy to help if they were asked. They just don’t know how to offer help.

Regardless of how they get help, caregivers should seek ways of reducing the burden of care, thus taking better of the caregiver!


      Assistive Dining at its Very Best

The Mealtime Partner Dining System provides the means to eat independently for those who are unable to feed themselves in the traditional way. Because of its flexible design it can be configured to meet the needs of almost any user and will allow a relaxed, enjoyable meal that is under the control of the person eating. They are free to take a bite of food when they want, and to pause between bites for as long as they choose. Thus they are empowered to have a traditional mealtime and will never be hurried.

Because the Mealtime Partner has three different mounting systems, as well as it being placed directly on a table for use, it can be positioned to meet the need of a diverse range of users. The Support Arm allows the spoon to be positioned to deliver food very close to the user’s lips. A small forward movement of the head can access the food on the spoon to be eaten. The Support Arm is suitable for individuals who have very limited or no extremity control because it can be fine tuned to the necessary position to provide access for them.

The Mounting Shafts provide comfortable positioning of the Mealtime Partner for those who sit close to a table but are unable to put their knees under the table because they are restricted by their wheelchair or for any other reason. The Shafts allow the device to pivot away from the table to allow easy access for users. Shafts come in five different heights.
Mealtime Partner on Support Arm

The Mealtime Partner Assistive Dining Device Mounted on the Support Arm

The Mealtime Partner 

The Mealtime Partner Mounted on a 6-Inch Shaft

For those users who are able to sit at a table with their knees under it to eat, the Mealtime Partner can be mounted on legs. The legs position the device at the appropriate height for each user. Legs are supplied in three different heights.

For additional information, please call us at
800-996-8607, or email our staff for assistance by clicking here.
The Mealtime Partner 
  The Mealtime Partner Mounted on 6-Inch Legs
The Mealtime Partner Assistive Dining Device is only available from Mealtime Partners, Inc. or Select Dealers.

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