Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

June 2016 Independent Eating and Drinking Newsletter

	June Topics: Using Straws for Safer Drinking One-Way Valves for Straws
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Using Straws for Safer Drinking

During a recent presentation about assistive technology for eating and drinking the presenter touched upon the use of different types of straws and one-way valves. The question and answer period brought lots of questions, many of which did not get addressed because of time constraints. It was obvious that many people are interested in knowing more about this topic, but it is not a subject that is generally addressed in any kind of detail, possibly because it seems so insignificant. However, it is an important topic that can lead to success or failure with independent drinking. Because of Mealtime Partners comprehensive background in eating and drinking equipment we are aware of the pros and cons of different types of straws and about one-way valves. We hope that the following articles will provide details about straws and give insight into how to choose the best equipment for each individual.

Drinking through a straw or tube is an easy way to get liquid without having to lift and/or tip a cup or glass. Drinking through a straw puts the consumer’s head in a downward position. This position creates a chin-tuck that facilitates safer swallowing. However, not all straws are created equal and this article will examine the pros and cons of different types of straws and drinking tubes and how they relate to different users. This article will focus on drinking thin liquids. It will not address considerations relating to the thickness of liquids being consumed.

There are many reasons why one type of straw doesn’t meet the needs of everyone. A few of the reasons are:

• Some people cannot pucker their lips into a tight enough “kiss” to make a seal around the straw.

• Others can only create a vacuum when the straw is placed into their mouth to the left or right, rather than centered, which completely prohibits them creating a pucker around the straw.

• Others need to tighten their jaw into a “bite” to be able to stabilize it sufficiently to be able to create enough suction to pull liquid up a straw. This action will crush many straws.

• Others have a bite-reflex that will crush soft straws.

• For others, consistent and extended lip closure is difficult.

The common differences between straws are: the diameter of the straw, the length of the straw, the flexibility of the straw, the rigidity of the straw, and, whether the straw is disposable or reusable.

The Diameter of Straws: The diameter of straws varies from very small, like those found in Juice Boxes, to some that are as big as 3/8 inch in diameter. For straws with a small diameter the user can either pucker their lips tightly to create a seal around them, or, the smallness of the straw allows them to purse their lips (i.e., press their lips tightly together rather than a pucker), resulting in lip closure that allows suction. Juice Box straws are quite rigid and do not easily crush unless they are bitten with teeth. For larger diameter straws, users must be able to pucker their lips. Also, larger diameter straws facilitate drinking somewhat thicker liquids, like soup, milkshakes, etc.

The Length of Straws: The ability to use longer straws depends upon the user’s capacity to suck (i.e., create a vacuum in their mouth). When all else is equal, it is easier to suck liquid through a short straw than through longer lengths. If a user has good suction, using a longer straw allows them to have their drink holder positioned farther away from their mouth (see November 2009 Newsletter for information about positioning drink holders).

The Flexibility of Straws: The common use of the term flexible straw refers to a disposable straw that has a short corrugated section close to one end of the straw. This allows the straw to be bent and positioned for access by the user. This type of flexible straw can be inexpensively purchased in boxes at the grocery store. They are commonly used in hospitals when it is impossible to have the user sit up completely to take a drink. It should be remembered that this drinking position (i.e., reclining) puts the user at risk of aspiration, but in some circumstances, cannot be avoided. Many people like the angle that can be achieved using flexible straws because it allows the end of the straw to be positioned directly in front of their mouth.

Another form of flexible straw is made of polyethylene. Polyethylene reusable straws are somewhat pliable and, therefore, can bend. Also, they can accommodate being bitten by the user without collapsing.

The Rigidity of the Straw: Some reusable straws are made of Plexiglas® and are completely rigid. They have the advantage that they can be heated with a heat gun and bent to accommodate the user’s positioning needs. After cooling, the bends in the tube will be permanently maintained. However, due to the rigidity of these straws, an individual will probably be required to use it when it is positioned in the center of their lips to create a good seal. They must also be able to pucker their lips, and they do not need to clench their jaw over the straw to be able to suck. Rigid straws have an additional benefit in that they will not crush if they are bitten.

Disposable Straws: Disposable straws can be purchased by the box at grocery stores, either unwrapped or individually wrapped. Almost all straws that are sold at grocery stores are 7 ½ to 8 ½ inches long and have an approximate (outside) diameter of  ¼ inch. Many different length and diameter disposable straws are available at fast food restaurants, convenience stores, or bars. Often these organizations are willing to sell or give a box of straws to someone who asks for them. Disposable straws are very convenient to use because they can be used once and thrown away. This is an important hygiene consideration because straws are very difficult to wash. Disposable straws have one serious short coming for some individuals, they crush when bitten. And, once bitten, the flow of liquid is restricted or stopped. However, disposable straws are by far the best choice if the straw is long enough and crushing the straw is not an issue for the user.

Reusable Straws: Many cups and bottles, including some sold by Mealtime Partners (MtP Drinking Systems), are supplied with reusable drinking tubes as part of their structure. Also, reusable straws can be purchased separately. They come in assorted lengths and rigidity of material. The diameter of most straws range from 1/8 inch to 1/4 inch and the lengths vary from 7 inches to 18 inches. Many reusable straws, even though they are too long, can be cut to shorter lengths. (If they are cut, special attention should be paid to the end that is cut to be sure that the straw does not have any sharp edges. A fingernail file or fine sandpaper can be used to smooth rough edges. Also, be sure to properly sanitize the straws before use, if cutting is required.)

Hygiene is another issue when using reusable straws. It is difficult to be sure that they are well cleaned and sterilized. If the user bites down on the straw, after a few uses special attention should be paid during washing to the teeth marks at the end of the straw. Small brushes to clean the inside of the straw are available from Heart Rate Monitors, and health department recommendations for institutional cleaning should be used to clean all straws. Their instructions are are to clean both the inside and outside of the straw as follows: i.e., wash in hot soapy water; scrub the interior with a brush; hot rinse; bleach water rinse; and, finally, a second hot rinse, drain and let dry.

Oxygen Tubing: A good solution for a user who is not able to use a rigid straw because they cannot close their lips around it, or who crushes a disposable straw, is to use crush-proof oxygen tubing as a straw. Crush-proof oxygen tubing has an interior structure called star, or lumen, which prevents crushing (as shown in the picture inset to the right, below). The same principle that guarantees the delivery of oxygen, applies to liquids. The interior ridges keep the tube open enough for liquid to flow through it even if it is bitten. The advantages of using oxygen tubing as drinking straws are:

• Even if the tube is bitten hard, the liquid can still pass through the tube into the user’s mouth.

• Many individuals must clench their jaws hard to stabilize their mouth around a straw, and oxygen tubing allows them to do this without prohibiting the flow of liquid.

• The tube can be placed to the right or left of the user’s mouth and no puckering of the lips is needed.

• Oxygen tubing can be cut to the desired length for the individual drinking.

• After it has been used a few times it can be thrown away because it is inexpensive.

In summary, it should be noted that drinking through a straw typically puts the individual’s head at a safer angle to drink than using a cup or bottle. When caregivers offer people a drink out of a cup or bottle they tend to be in a standing position to provide the drink, and when doing so, by default, are above the person’s head level. The natural action of the person getting a drink is to lift their head towards the person holding the cup. This position exposes the person’s airway unnecessarily to choking. Therefore, drinking through a straw should be encouraged.

In addition, straws are essential for totally independent drinking systems. Due to the great importance of proper hydration, Mealtime Partners recommends that everyone be provided the means to drink at any time they wish, and that drinking not just be made available at mealtimes.

Independent Drinking

For most individuals, dehydration is 100% preventable. However, many people with disabilities suffer from some level of dehydration almost constantly. Mealtime Partners various drinking systems allow many individuals who are unable to use their hands to take a drink, to drink independently. For example, the Hydration Backpack with Drinking Tube Positioning (pictured below) provides hands free drinking throughout the day for those who sit in a wheelchair and are unable to lift or hold a cup or glass. The drinking system is quick and easy to set up, the liquid container fits on the back of a wheelchair and the drinking tube can be positioned to meet the unique positioning needs of each individual.

Easy to install and remove from the wheelchair to fill or clean.

Hands-free drinking, 70 fluid ounces of water available for people on the go!

The Front Mounted Drinking Systems pictured below, can position a variety of cups and drink containers very close to the users mouth for hands free drinking and allows a variety of other drinks to be made available throughout the day. For example, coffee in the morning, ice tea with lunch, a can of soda in the afternoon and a glass of milk before bed. The user drinks from their own container using a disposable straw. Because the straws and most of the containers can be disposed of, or washed in a dishwasher, it is the easiest drinking system to clean. It is available in several lengths of flex-arms and can be mounted on a variety of wheelchairs.

Front Mounted Drinking System with UniTrack Mounting Front Mounted Drinking System on Manual Wheelchair

All of the Mealtime Partners drinking systems are available for attaching to manual wheelchairs (i.e., wheelchairs with a tubular handle or other tubular structural components) and for wheelchairs with the Slide-Track mounting rails. For more information about all of our drinking products, click here, or call us at 800-996-8607.

One-Way Valves for Straws

One-way valves for drinking straws are designed to cause the straw to remain filled with liquid even after the straw is removed from the user’s lips. These valves are designed to assist individuals who have swallowing disorders.

One-way valves come in two forms: a small insert that contains the valve that is put into the bottom end of the straw (pictured below, right); and, a valve that is built directly into a straw. The valve contains a small ball that rises to the top of the valve when liquid is sucked up through the straw. When the user stops sucking, the ball falls to the bottom of the valve housing and stops the liquid in the straw from flowing backwards out of the straw. Thus, the straw is full of liquid the next time the user takes a drink.

One-way valves are used for the following purposes:

• They serve the needs of individuals who intake excessive amounts of air as they drink through a straw. Because the straw is full of liquid, the user only intakes liquid rather than first sucking in air and then liquid.

• To make it easier for people to drink through a straw because, theoretically, if the straw is full, the user will have to suck less. Unfortunately, to suck through a straw that has a one-way valve in it, is more difficult than sucking through a regular straw. Therefore, Mealtime Partners cannot recommend using a one-way valve for this purpose.

Recommendation: Before providing a straw with a one-way valve to a client, the clinician should try using one. You will probably be surprised how much suction is needed to pull liquid up a straw with a one-way valve in it.