Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

July 2017 Independent Eating and Drinking Newsletter

	July Topics: Why Not Use Forks for Assistive Feeding? Oxygen Tubing versus Drinking Tubes
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Why Not Use Forks for Assistive Feeding?

Over the years, one of the questions that we are regularly asked is, “can you put a fork on the Mealtime Partner?” The answer is no. The next question is, “why not?” This article will explain why the Mealtime Partner doesn’t utilize a fork and some of the reasons why a fork is not always an appropriate utensil for feeding someone who is not able to eat independently.

First, why doesn’t the Mealtime Partner have a fork as an alternate to the spoon the device uses? When the Mealtime Partner was designed, one of the significant issues that had to be overcome was that the currently existing powered feeding devices had serious problems with reliably picking-up food. To surmount this problem the Mealtime Partner design radically changed the prevailing concept of using a plate by utilizing three deep bowls that mounted on a Lazy Susan style support. The curvature of the bowls mates with the shape of the spoon as the spoon sweeps through the bowl. Additionally, because the bowls have steep sides, gravity pulls the majority of the food to the bottom of the bowl, allowing the spoon to sweep through the majority of the remaining food. With the matching shape of the bowl and spoon (and the spoon path), food pickup is maximized. Covers were then added to the top of each bowl and the Covers control the volume of food that is on the spoon. Three different Covers are available and the range of size of servings is: a level spoonful; a rounded spoonful; and a lump or two of food (i.e., a large spoonful). This control of the volume of food served can only be accomplished by the combination of a spoon and bowl that have matching curvature, and have Covers that control food volume once the spoon has picked it up. Therefore, the quick answer to the question is that for a powered dining device, food pickup is easier and more complete using a spoon to scoop up food.

Forks are most commonly a western utensil, while chopsticks are favored in Asian cultures; both cultures also use spoons. A fork consists of a handle at one end, and tines at the other end. The number of tines on a fork varies depending upon what the fork is used for. Four tines are the most common number found on a standard dining utensil; however, a fork used to eat dessert is likely to have three tines and be smaller than a standard fork. A fork used for calving meat will usually have only two tines.

Forks are primarily used in two ways: First, a fork is used to spear food and lift it into the mouth; secondly, a fork is used to stabilized food and hold it in place while it is being cut into pieces. Whether a fork is being used to hold food or lift food, the tines, by necessity, must be somewhat pointed to enable them to penetrate the food. In American culture, food is additionally scooped up using the fork in a similar manner to using a spoon, while in European cultures this is uncommon.

When we feed ourselves, we can easily pick a piece of food up off of the plate by spearing it with a fork and lifting the fork to our mouth. Inserting the fork and food into our mouth is easy and does not require conscious thought to execute. Now imagine that you are eating and have a tremor. First, sticking the fork into a piece of food may be more difficult because your hand is moving; now imagine raising your hand and putting the food into your mouth. What you might find is that getting the food into your mouth becomes a challenge as your hand is unstable. You might miss your mouth, or be off center, or even worse you might hit your lips, cheeks or chin. This is usually painless if you have food to act as a cover for the ends of the tines of the fork, but if the tines are sticking through the food, you might get poked by the tines. Even worse, if the food falls off of the fork as it is being raised to your mouth, you might poke yourself with the fork and hurt yourself. With this scenario in mind it is understandable that individuals who have difficulties coordinating getting food into their mouth might be given a spoon, rather than a fork, to eat. However, the picture does not improve when a spoon is used because it is very hard to keep food on a spoon if you have uncoordinated movements or a tremor when lifting a spoon to your mouth. For most people the majority of a meal is eaten using a fork, however, they may transition between a fork and a spoon, if they are eating soft or runny food as well a lumpy food.

Returning to the discussion of using a fork with the Mealtime Partner, two problems must be addressed to make a fork function with a powered dining system. The fork must be inserted into lumps of food, and then must present the piece of food to the user. Reliably being able to stab a piece of food and have the food stay on the fork is quite a challenge for a feeding device. The important word is reliably. It is of little value to a user to be offered an empty fork (or spoon) and this can be very frustrating for them if they are hungry.

 Now, consider that an empty fork is presented to the user who has involuntary movements. If they make a move towards the fork (to take the food), they could accidentally bang into the ends of the tines and hurt them self. Banging into the tip of a spoon is far less likely to hurt. The engineering challenge for using a fork is to pick up lumps of food with a fork, repeatedly! So far, no one has been able to design a mechanism that can consistently perform this function. Even if this is accomplished, the issue of moving between lumpy food and soft food will then have to be addressed.

There has only ever been one powered dining system that has used a fork and that was a device made in Japan called My Spoon (this device was never marketed in the United States, and is no longer on the market). However, it did not stab food with the fork but used the fork in combination with a spoon to hold the food onto the spoon while it was being moved towards the user’s mouth. Once close to the user’s mouth, the fork was retracted and the food eaten off of the spoon.

Additionally, some developers of robot arms have managed to have the gripper of the arm hold a fork and the arm can be manipulated to stab a piece of food and then raise the fork to the user’s mouth; however, this is a tedious and time consuming exercise for the user and still presents the risks of the user being hurt by the fork, and thus is not a viable solution to independent eating.

Because the highest priority in the design of the Mealtime Partner Dining System was safety, a fork was rapidly removed from consideration. The design team’s primary goal was to serve a meal of different textures of food, safely and comfortably to each user, meeting the needs of each individual regardless of their disability.

Safety is still, and always will be, Mealtime Partners, Inc.'s top priority in the design of all of their products whether for eating or drinking.

Click on the following link to learn more about the Mealtime Partner Dining System, or call 800-996-8607 to talk to our staff about your specific needs.

The Mealtime Partner Dining System
For those who have cerebral palsy or a tremor, the Mealtime Partner can provide mealtime independence allowing a pleasant dining experience that is totally under the control of the individual eating.
The Mealtime Partner Dining System can be positioned to meet the specific needs of each user. The user does not have to adjust their position to eat using the device because the Partner’s flexible mounting systems permit positioning to fit the user's needs, making mealtimes a comfortable, relaxed experience, with the user positioned safely for eating. The Mealtime Partner empowers its user to eat what they want, when they want it. 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. All of the primary training videos can be found at Training on our website. For more information about the Mealtime Partner Dining System, please visit Mealtime Partners website. There is no other assistive dining system that meets the needs of the users, like the Mealtime Partner.

Oxygen Tubing versus Drinking Tubes

If you look at Mealtime Partners Drinking Products you will see that we offer Drink-Partner Drink Tubes and Drink-Partner Oxygen Tubing (products 5 and 6 from the top, just below the Drink-Partner). This article will explain why we offer both of these types of tubes and the pros and cons of each. For greater details about straws in general, please refer to Mealtime Partners December 2009 Newsletter which provides a thorough discussion of the range of straws that are available and their application. (Custom straws used by individuals with disabilities are commonly referred to as drink tubes.)

Drinking Tubes - Mealtime Partners Drinking Tubes are appropriate for individuals who have normal oral motor control and suction. The tubes are relatively rigid and, therefore, the user must be able to pucker their lips around the tube to create suction. Additionally, because the tubes are 37 inches long, the user should have normal (i.e., not weak) suction to enjoy drinking from them. The tubes are reusable. However, if they are used for drinking dairy products or sugary drinks they should be replaced more frequently than if they are used for drinking water. Of course, all drinking tubes need to be washed on a daily basis, just like eating utensils are washed after being used. But, because tubing is difficult to wash thoroughly, milk and juice may gradually leave residue inside of the tube and thus the tube should be replaced periodically. To wash the tubes, first soak them for several minutes in hot soapy water and swish them around in the water; then run hot water through the tube to rinse it. Drain the water out of the tube by positioning it vertically, and let the tube drain overnight before reusing. Once a week, after washing, soak the tube in a solution of hot water and bleach (about 1 tablespoon of bleach to a gallon of water). Rinse thoroughly with hot water.

The tubes that come with the Drink-Partner are rigid to allow them to penetrate to the bottom of the liquid container, through the drink that is being provided. This is especially important when the drink container is filled with ice. Softer tubes can bend when being inserted into icy drinks. Also, be careful not to let the end of the tube to be positioned directly on the bottom of the container as it might prohibit the flow of liquid into the tube. Curve the bottom of the tube slightly so that the end is not blocked in any way.

Oxygen Tubing – The oxygen tubing that Mealtime Partners sells for drinking is crush-proof oxygen tubing. The interior of the tubing has walls, or lumens, that prohibit the tubing from completely collapsing even when it is under pressure. For the person who is oxygen dependent, this prevents the tubing from being inadvertently crushed, thus cutting off the user’s oxygen supply. Although, not as critical as oxygen flow, this same principle applies to liquids passing through the tubing. Liquid will be able to pass through the oxygen tube even if the tube is being compressed. 

Some individuals have difficulty puckering their lips enough to be able to create a vacuum and suck through a rigid drink tube. For them, drinking through oxygen tubing might be the solution. Oxygen tubing used as a straw, or drinking tube, can have some advantages over using a rigid drinking tube. The user is able to bite the tube and have it compress between their teeth. This can help to stabilize their jaw and allow them to seal their mouth and create a vacuum, thus allowing them to suck liquid up through the oxygen tubing. Even when they bite down, liquid can still be sucked up through the oxygen tubing. Also, they do not need to pucker their lips around the tubing, which requires the tube to be placed at the center of their lips. The tube can be put into the mouth at the left or right side of the mouth rather than needing to be centered. For some people side entry of the tube allows them to create a vacuum when they are unable to do so with the tube being placed centrally between their lips.

The disadvantage of using oxygen tubing is that it is more difficult to position it in the drinking container so that the bottom of the tubing is at the bottom of the container because it tends to curl. Having it reach the bottom is necessary if all of the liquid is to be consumed. This problem is much more difficult if there is ice in the container. However, if an individual is only able to drink using oxygen tubing, chilled liquid can be placed in the container rather than using ice. Or, ice can be added after the oxygen tube is in the container by lifting the lid slightly and inserting a few ice cubes one at a time.

Mealtime Partners Oxygen tubing is sold in a 7 foot roll. The tubing can be easily cut into the appropriate length necessary for the drinking system in which it is to be used.

For more information about these drinking tubes, email (info@mealtimepartners.com) or call Mealtime Partners at 800-996-8607 to talk to a representative. For information about all of Mealtime Partners Drinking Systems, click here.