Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

January 2015 Independent Eating and Drinking Newsletter

	January Topics: Good Seating and Positioning for Eating and Drinking Sitting in a Wheelchair to Eat

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Good Seating and Positioning for Eating and Drinking

In 2015 we will try to provide readers with a broad overview of subject matter that is relevant to safe and enjoyable eating and drinking for those individuals who have difficulties eating and drinking independently. The January 2015 Newsletter will focus on seating and positioning to facilitate safe chewing and swallowing. The first article will address safe eating in general, and the second article is specifically for individuals who sit in a wheelchair to eat.

Everybody eats, obviously if you don’t you will eventually die. The result of not drinking is the same, but if you don’t drink you will die far more rapidly from dehydration that you will from starvation. Understanding that everyone, regardless of age, nationality, gender, state of health, or where you live, must consume nutrition and liquids habitually, leads us to recognize that because of the repetitive nature of eating and drinking it is essential that they are always conducted in a safe manner. If they are not, the result can be frequent choking and/or aspiration of food or liquid.

Even the fear of aspiration can lead to health problems. Many people who are at risk of aspiration reduce their intake of both liquids and solids just because they are fearful. This fear often results in an individual who is either slightly dehydrated or slightly malnourished constantly, or both.

Appropriate seating and positioning can lessen the risk of aspiration. For those of us who are able to conduct these tasks independently, we automatically move ourselves into the appropriate position to safely consume food and liquid. However, for anyone who is unable to eat and drink independently and must be provided food and drink by another person, proper positioning while being fed can reduce the risk of aspiration, significantly. Many people who are fed are able to move themselves into the appropriate position to be fed comfortably and safely, but in some cases they do not know, or understand, how to position themselves to safely receive food or liquid. Many such individuals have developed habits that were developed for expedience rather than safety. For example, for someone who has poor lip closure, if they tip their head backwards with their chin upward, it is easier to keep food and liquid in their mouth. Even though this position increases the volume of food and liquid retained in the mouth per bite, and ultimately the volume consumed per mouthful, it increases the risk of aspiration. Therapists, caregivers and family members who work with individuals who position themselves in a way that reduces their safety, should help the person to develop different habits to enable them to consume liquids and solids as safely as possible. This may mean that it takes them longer to eat and drink and/or that less is retained in the mouth per bite, but safety should be the highest priority. For those who have less independent control over their body, assistance must be provided to situate the person in an appropriate position to safely chew and swallow.

Before discussing aspects of seating and positioning it is recommended that the reader conduct a simple experiment. Get yourself a drink and sit down. Do not lean back against the chair back. Take a sip of your drink. As it goes into your mouth think about where it is initially located in your mouth, and what happens as you swallow. What areas of the mouth does the liquid move through and what is your mouth doing through the sip and swallow process? Now lean back against the chair and repeat the process. You will notice that the liquid pools in a different location in your mouth depending upon your level of recline. Also, the way in which you swallow will change as your body position changes. This exercise is helpful when thinking about positioning someone who is going to be fed, or provided a drink.

Achieving a good position for eating requires that the trunk is very stable. To enable the trunk to be stable, the feet must have a firm footing so that they can bear weight while the person is eating. Feet that dangle off of the edge of a chair cannot help the person become stable. Therefore, for someone who is short (or a child), a foot stool should be provided if their feet do not reach the ground. Additionally, the thighs and buttocks should bear weight. Think back to the exercise that was discussed in the previous paragraph, when your body was reclined, your thighs did not fully bear the weight of your body. When the feet, thighs and buttocks bear weight, the body becomes more stable and the shoulders, arms, and head are able to maintain a more constant, steady position. This will promote better control of not just the head and neck, but all of the muscles in the jaw, tongue and mouth. The overall result is that the person will eat more safely and gain better control over eating and drinking.

The overall objective of good positioning for eating is to provide the body enough stability that the muscles involved in eating can perform at their best. With a stable body, people are able to better control their muscles and, therefore, they are able to chew more productively, manipulate the food in their mouth with greater ease, and swallow safely. Eating in the right position over an extended time can result in improved muscle tone and thus better overall oral motor control.

Once the feet, legs and buttocks are appropriately supported and positioned, the trunk should be situated over the buttocks. If the trunk reclines rather than being erect and over the buttocks, the body does not have the best level of stability and is less able to control the functions needed for eating. For those who are unable to maintain this upright position using their own muscle power, support should be provided. This can be achieved by the use of a chair with a vertical back and arm rests. If necessary, small pillows or towels can be positioned around the individual to further support them in the chair. To avoid the person leaning backwards as the meal progresses and they begin to tire, further propping behind their back may be helpful. It should be noted that if padding is added around the person while they eat, it should be placed in a manner that is comfortable and not just wedged in around the chair.

When a good stable trunk position is achieved, the head and neck will lean slightly forward and a natural chin-tuck position will be achieved (a chin-tuck is when the chin is slightly downward towards the chest, which is the desired chin position for safe swallowing). Also, when eating at a table, the individual’s knees can be under the table far enough that their hands and forearms can rest on the table. This provides additional stability. When resting your forearms on a table they should be close together; in this position you naturally lean forward towards the table and round your shoulders slightly. This position encourages the individual to hold their head in a chin-tuck position, and promotes safe chewing and swallowing.

For anyone who is going to provide mealtime support to another person, it is helpful to experiment by positioning yourself in the required position to understand what muscles are being used, and how support can be best achieved.

Regardless of the situation, good, well supported, seating and positioning can make a meal more comfortable and enjoyable as well as being a safer way to eat.

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 Dining System 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.

Sitting in a Wheelchair to Eat

The previous article in this month’s Newsletter discusses positioning for safe eating. However, when someone is going to be fed while they sit in a wheelchair there are other things to be considered beyond those discussed in the first article.

Many people with disabilities sit in wheelchairs to eat and are unable to freely position themselves within the wheelchair. Many of these individuals remain in the same position while conducting all tasks. Commonly, this position is specifically designed for safely transporting the individual, not for performing other tasks. Wheelchairs are primarily designed for mobility. For those who are pushed around in their wheelchair, the chair is made to comfortably and safely allow the individual to move from place to place. For those who have a powered wheelchair, their positioning allows them to be comfortable and safe, and, at the same time, able to see clearly where they are going (which facilitates safe driving). When someone is transported in their wheelchair by bus or van, whether it is a manual or powered wheelchair, the most important issue is that they are conveyed safely. Therefore, their positioning in the chair is designed to accommodate that.

However, the position required for mobility is not necessarily appropriate for performing everyday tasks. For example, in that position it would be very hard to write, or even read, because they are not leaning forward.

The way someone sits at mealtimes can seriously impact their ability to create a safe swallow. To reduce the risk of choking and/or aspiration for those who eat while sitting in their wheelchairs, their positioning should be adjusted prior to eating to allow them to chew and swallow comfortably and safely. During meals the wheelchair should be as up-right as possible. Foot positioning is normally dictated by the wheelchair foot-rests, and, therefore, it is important to make sure that the footrests support the feet adequately and allow the thighs to bear weight. If the individual has shoulder straps that restrain their upper body from moving forward, slightly loosening the shoulder straps should be considered to allow a small forward movement of the shoulders. First try loosening one shoulder strap to see if this freedom of movement is enough to encourage the head to move forward and down. Placing a small wedge or rolled-up hand towel behind the individual’s shoulders can encourage this position.

If the person has poor muscle tone and is pulled forward by gravity when they lean forward past the upright, 90 degree position, producing a chin tuck can be more difficult. However, a chin tuck (described in the first article) can be produced while the person is sitting in a slightly reclined position (to avoid the impact of gravity) by supporting the shoulders in a forward, or rolled, position. A neck pillow can provide support for the head, and placing rolled hand towels or a small pillow under the shoulders can help shoulder positioning. In this way the pull of gravity is overcome and yet a chin tuck is produced.

It should be noted that while achieving a shoulder roll (i.e., pulling the shoulder forward and down slightly), you do not want the individual to collapse their trunk because it will put pressure on the stomach and increase the occurrence of gastro esophageal reflux (GERD) during and after eating. You must locate the position that allows a chin tuck but does not cause the trunk to collapse.

A laptray on a wheelchair is often a benefit for individuals who have difficulty maintaining their trunk stability. Their forearms can rest on the laptray while eating, and can bear the weight of the shoulders. This position will bring the individuals shoulders forward and produce a chin tuck. However, if the individual leans too far forward on the laptray, pressure will be put on their stomach, either from the laptray physically pushing on their stomach, or because their ribcage is resting on their stomach because they have collapsed their trunk; both are unhealthy for eating and digestion.

If a wheelchair does not allow an individual to sit appropriately for eating it is recommended that a physical therapist, occupational therapist, and the wheelchair vendor be consulted to decide if adjustments can be made to the wheelchair that would allow its occupant to be positioned correctly for eating. Eating and drinking are tasks that are undertaken throughout every day and it is important to make sure that each individual can eat and drink safely and comfortably, regardless of how they sit and what their abilities are.

Did You Know? Did you know that to help someone become stable while sitting down to eat, it is useful for them to stagger the position of their feet on the floor rather than them being side by side in front of their body? One foot should be under the knee, or slightly in front of the knee, while the other foot should be under the thigh. Putting a foot under your thigh will require the foot to bend and the toe will rest on the ground while the heel is raised off of the ground. The feet should be apart from one another by approximately six inches. Commonly, people move their feet throughout the meal to stabilize them while eating.

Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

January 2015 Independent Eating and Drinking Newsletter

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