Mealtime Partners, Inc.

MtP Tip of the Month: It is a good idea to practice how you will help someone who sits in a wheelchair and uses a chest strap (or other type of harness), and is choking. Everyone who works and/or lives with the individual should know exactly how to react if the individual were to choke. It is easy to develop a “script” of steps to be taken and post it somewhere where it is readily available. This allows everyone to react efficiently and effectively should a problem arise, and lessens the risk of the foreign material that has caused the choke to be inhaled further into the windpipe.

Good Buttocks Positioning Promotes Safe Eating

Buttocks are the rounded portions of the anatomy located on the posterior of the pelvic region. They are formed by the masses of the gluteal muscles covered by a layer of fat of varying thickness, depending upon the individual. The buttocks allow us to sit upright without having to rest our weight on our hands or feet, to balance ourselves.

Stable positioning of the buttocks facilitates the body coordination necessary for safe and comfortable eating. If the buttocks and thighs are well supported and are weight bearing, the trunk, shoulders, neck and head have a firm platform beneath them and are more able to produce the well-coordinated movement(s) necessary to produce harmonized chewing and swallowing that is essential for safe eating.

To gain an understanding of the significance of having stable buttocks at mealtimes, it helps to look at the situation in reverse; if someone’s bottom is unstable and able to slip forward or backward in their chair, or is able to roll from side to side, the trunk will follow the same movement patterns. The instability of the body leads to an unstable neck and head. Therefore, the mouth, tongue, and their associated muscles, lack the firm platform necessary to chew easily and effectively. Also, the throat is not necessarily positioned in an optimal alignment to swallow the bolus (i.e., the ball of chewed food ready to be swallowed) once it is formed in the mouth. This introduces the risk of choking and/or aspiration.

For those who sit on a standard dining chair at mealtimes, the seat of the chair should not have a slick surface that allows the person sitting in the seat to slide. To counter this situation if the seat is polished (i.e., exhibits low friction), use a sheet of Dycem³ on the chair. This allows firm buttocks positioning on the seat and avoids undesirable movements. The person is still able to reposition themselves if they desire to do so, and yet, they do not move unintentionally. (If Dycem isn't available, be innovative. Use other materials that will create friction on the surface of the chair.)

For those individuals who sit in a wheelchair to eat, the seat of the wheelchair should be evaluated to see that it provides adequate stability for the buttocks at mealtimes. There are too many different seats on wheelchairs to address specifically so this discussion will be generic, describing only some of the more common types of wheelchair seats. Most manual wheelchairs have a sling type of seat. Fabric is suspended between the two outer rails of the chair (like a child’s swing seat). This type of seat does not provide a very firm surface for the buttocks and attention should be paid to the positioning of the buttocks in the chair. The eater should be positioned as far back in the chair as possible. Also, their feet should either rest firmly on the ground, or on foot rests, to provide stability to the thighs and allow them to fully bear weight. Lastly, if the person sitting in the chair has a tendency to slide forward or slouch in the chair, a lap-belt is recommended for mealtimes.

For those wheelchairs that have a solid surface seat, the most pressing issue is related to how the seat accommodates the buttocks. Is the seat contoured or flat? For flat seating surfaces (even when they have padding), the same rules apply as for sitting in a dining chair (as described earlier). Additionally, how the thighs and buttocks are supported by the outer edges of the seat and wheelchair should be evaluated. If there is a gap down the sides of the chair on one or both sides, how the user sits during eating should be assessed to make sure that they do not roll from side to side on their thighs and buttocks. If they do roll, it is helpful to place a rolled hand towel (or wash-cloth, for small children) in the gaps during meals.

If someone has a contoured seat, the seat was designed to meet their specific needs and we do not need to discuss the details of how a contoured seat should be fitted. However, contoured seating should be checked periodically to see that it still contours to the individual’s buttocks and thighs and that no wearing of the seat has reduced the support provided by it. The location of the individual’s buttocks should be checked prior to a meal to be sure that they have not slid forward (even slightly). As children who have contoured seats grow, they are likely to be less stable in their seat as their body no longer fully forms to the seat.

Another factor that should be considered relating to buttocks positioning necessary for safe eating is the impact of both abnormal voluntary movement patterns and involuntary movement patterns. It is common for people who have abnormal movement patterns to use them in combination with voluntary movements in an attempt to stabilize their body to accomplish a task. Appropriate seating and positioning can reduce this movement activity, reducing the calories burned to support this movement, and to help produce more coordinated movement.

A final note about positioning for eating is that after the buttocks are appropriately positioned and stable, the next goal is to stabilize the mouth. People who have involuntary movement often will move around during meals. Because of that movement their body will become unstable, producing the forward, backward, and sideways rolling motion during mealtimes, described earlier. People who feed individuals should try to place the spoon in front of the consumer in the same place for each bite. When feeding someone, we are inclined to move to the person’s mouth in an attempt to make eating easier. However, over an extended time the person being fed will benefit by a constantly positioned utensil. Their body will have the opportunity to “learn” how to coordinate mouth positioning with spoon positioning. Muscle memory potentially can develop over time improving the individual’s body stability at mealtimes. With the buttocks firmly positioned in the same position meal after meal, coordination should improve.

The Mealtime Partner Dining Device spoon is positioned in the same place bite after bite, allowing the user to become familiar with a stable, repeatable spoon position. This is an advantage of using assistive technology for aiding individuals who cannot self-feed (not to mention the reduced risk of aspiration and the many psychological benefits of independent eating).

Independent Drinking For most individuals, dehydration is 100% preventable, yet many people with disabilities suffer from some level of dehydration almost constantly. The Hydration Backpack Drinking System with Drinking Tube Positioning 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 mount, 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. Making liquid constantly available allows the user to drink whenever they want. This lowers the risk of dehydration and improves the quality of life for those who have this system. For more information about all Mealtime Partners drinking systems and information about choosing the most appropriate drink system, click here. Click the following link for pricing and/or for ordering the Hydration Backpack Drinking System with Drinking Tube Positioning.
The Hydration Backpack with Drinking Tube Positioning is	only available from Mealtime Partners, Inc