Mealtime Partners, Inc.

Eating Cuff Holding Utensil	Wrist Support with Eating Cuff

2. Loading food on to the spoon. Foods that stick to a spoon, like yogurt, pudding or thin mashed potatoes, should be used when first learning to feed oneself. This provides some food to the user while they are learning how to reliably pick up food, and maintains their interest in learning rather than them becoming frustrated by the lack of success at acquiring food. It is advisable to only practice independent eating when the person learning is not very hungry. When hungry, frustration can interfere with learning. A scoop dish helps get food onto a spoon more easily than a standard bowl or plate (but a bowl is preferable to a plate if a scoop dish is not available). The location of the scoop edge makes a significant difference in the action required to load food onto a spoon. If the scoop edge is facing towards the back (away from the user) the user will push their hand away from the body in an arm extension movement. However, if the scoop edge is facing forward (close to the user’s body) the hand action is towards the body, closing the bend of the elbow. This is a significant difference, and depending upon the user’s muscle tone and control, the scoop edge should be positioned to accommodate their most productive and repeatable muscle movement. Placing the dish on a sheet of Dycem will help hold the dish in place.

The Scoop Dish

3. Keeping the spoon on a level plain and raising it from the bowl to the mouth. To be able to feed oneself a wide variety of foods, it is essential that food stays on the spoon once it has been scooped. For this to happen the bowl of the spoon must be kept level as it is moved from the bowl to the individual’s mouth. This requires that the wrist, elbow and shoulder make subtle adjustments to the angle of the spoon as it is moved. This is a highly complex series of actions and is often too difficult to execute, and, as a result, the food spills off of the spoon. Several things can be done to simplify this task. First, eliminate the need for raising the spoon from the bowl to the mouth by positioning the bowl on a raised surface at (or near) mouth level. This can be accomplished by using an over-the-bed table or by placing a box of the appropriate height on the table. The box must be large enough to hold the bowl and allow the user to rest their elbows and lower arms on it. With this arrangement the user must only move their hand forward and backward, not up and down. The spoon can be loaded and moved to the mouth on (approximately) a single plane. To make this even easier, the scoop edge of the bowl can be angled either to the left or right and slightly forward, towards the user. This allows a sweeping movement of the spoon to brush against the scoop and load the spoon and the same movement to continue to the mouth. As the user acquires competence with this movement, the surface can be gradually lowered, increasing the complexity of the task very gradually as they learn greater control.

4. Inserting the spoon into the mouth. This might seem a very obvious part of eating, however, if you have always been fed, it is by no means obvious. If someone has always put the spoon into your mouth for you it is not intuitive to do it for yourself; it is a new experience and must be learned. Verbal prompting may be helpful to encourage independently putting the spoon into the mouth. Finding ones mouth with the spoon is an additional undertaking. Often the mouth is missed entirely or it takes several attempts to access it. Practice may improve this skill but those who have tremors, or other involuntary movements, will always find it difficult. Stabilizing the elbows and forearms (described earlier) makes it easier to access your mouth with a spoon. Arm/hand movements should be analyzed to evaluate whether gross movements or fine motor movements are easier for the individual to execute. This will help establish how to configure the dining environment to allow the user to get the spoon into their mouth with the least amount of stress.

5. Closing ones lips around the bowl of the spoon. Once again, it appears obvious to follow putting a spoon in your mouth with closing ones lips, but for those who have been fed all of their lives, it is not an automatic response. Many caregivers wipe the food off of the spoon, into the mouth, using the person’s front top teeth as a wipe edge. When this is the normal pattern of eating, the individual being fed holds their mouth open, rather than closing their lips over the spoon. When independent eating of any kind is introduced (self feeding or with assistive technology) the individual must learn to close their lips to remove the food from the spoon. First try verbal prompting. Both verbal and physical assistance may be needed to moderate this movement. If verbal assistance fails to achieve the desired results, physical assistance can be provided by gently helping the person close their lips over the spoon with your fingers. Repeat this help as many times as necessary. Remember to allow the individual, who is learning, plenty of time to attempt to independently create lip closure, prior to assisting them. It takes time, both cognitively and physically, to close your lips when it is a new experience.

6. Removing the spoon from ones mouth. When the spoon is in your mouth and your lips are closed around it, the next step is to remove the spoon from your mouth. The lips should be slightly relaxed but they should not be opened. This allows the spoon to be removed while the food remains in the mouth. Opening the mouth wider will allow food to fall out of the mouth or for the food to simply remain on the spoon. Physical assistance with holding the mouth gently closed can help the individual learn what they must do with their mouth when removing the spoon if verbal prompting alone does not work. Also, the individual must learn to coordinate their mouth movement with the hand and arm action necessary to remove the spoon from their mouth.

7. Returning the spoon to the bowl. The final step in completing the sequence of taking a bite of food is to return the spoon to the bowl. The action of removing a spoon from ones mouth tends to create an exaggerated arm movement that pulls the arm away from the body. Verbal or physical assistance may be needed to moderate this movement. If some food is remaining on the spoon, this movement might cause some spillage. Using a vinyl table cloth under the person’s chair can make clean-up easier. Practice will lessen or eliminate these problems.

Feeding oneself is a complex undertaking and within each of the seven steps described above are many demanding sub-tasks. For many individuals, independent eating is a strenuous activity that burns a great number of calories. Additionally, because it is such a demanding job, it can tire the individual. All of these aspects must be considered when looking at the long term goal of mealtime independence. Does the individual burn excessive calories feeding themselves? If so, they may benefit from assistance from a caregiver for part of a meal. Or assistive technology, like the Mealtime Partner Dining System, could be used to allow them to be fully independent in eating, while reducing the number of calories burned while eating.

Remember eating should be enjoyable and if it becomes a struggle, the pleasure of the experience is diminished. Feeding oneself by hand, does not have to be abandoned because it is difficult or tiring but it can be supplemented with the right equipment. A thoughtful blending of eating methods can provide a higher quality dining experience without sacrificing dignity or independence.