Feeding Assistance or making a person independent in feeding may not really seem like a physical therapy topic. Also, it is not that commonly encountered problem in orthopedic setting or high-level functioning individuals. Only until you start seeing patients with some neurological deficits or trauma. With my experience as a PT, one thing for sure is walking is an important aspect of independence but it is not the only aspect of functional independence. There are many tasks a person needs to do to perform his/her daily routine activities independently. Some of the examples of these are feeding, dressing, grooming, hygiene, moving in and out of bed, transferring on different surfaces and walking. You can add some more high-level activities like cooking, laundry, cleaning the house, grocery shopping and even driving but they are not really the basic tasks that a person will need to do on a daily basis.
If you have witnessed someone and experienced on your own how difficult it is to not able to bring the spoon towards your mouth or unable to lift a cup of your morning coffee, you exactly know how helpless it feels! Now the reason for this inability temporary or permanent. Or it may be one of the neurological progressive disorders where a person is gradually losing their independence like ALS or MS. Whatever the reason it might be, it is important to address the issue and help the person to our best ability.
In my previous articles, I talked about different types of transfer as well as different types of wheelchairs to address the similar issue of independence. Here, I want to talk about some tips to help a person feed themselves independently or with less help from others.
Why a person can not feed himself?
The first and foremost, we need to find out why a person is unable to feed himself. There can be an injury to the brain due to stroke, or TBI. It can be spinal cord injury or nerve injury (brachial plexus injury), nerve damage (either median nerve, ulnar nerve, and radial nerve) at a different level. The never injury can make a person be able to perform certain tasks and unable to perform or carry certain tasks depending on level and type of injury. For example, a person will complain of an inability to carry a glass of water with severe carpal tunnel syndrome. Fractures of forearm bones or wrist bones can make a person not able to use the fingers or arms or one or other side and make them dependent for feeding.
Some of these conditions are temporary and improvement is promising. Others like stroke or TBI depend on the severity, time of injury as well as part of the brain involved. In some conditions, we are trying to maintain the current functional status and prevent further decline. While in others, we are repeating the same movement to strengthen the neurological connection to help with feeding independence.
In anyways, a therapist (mainly a hand therapist or occupational therapist) may recommend different utensils that assist a person to feed himself.
How to Feed one’s self?
Feeding, taken so granted, is actually a complex task involving multi joints, as well as coordination. You are using your shoulder, elbow, wrist, and finger muscles with different contractions. Additionally, one needs perfect eye-hand coordination as well as a finger to mouth coordination to complete the task. Not to mention the strength and muscle work involved in cutting the food.
If this is not enough, chewing and swallowing can be a problem in many patients. Now I am not really going to discuss these pathologies in this article. I want to discuss some assistive devices that are available to help with feeding.
As I mentioned feeding is a complex act and it requires a lot of muscle movements as well as coordination. To help a person feed, we need to figure out what area he or she needs helps with. It is also important to check for vision problems as well as neuromotor sequencing problems. In other words, issues like poor vision, or impaired depth perception, may need some medical assistance than just feeding devices. Similarly, if a person can not figure out the proper steps involved in the feeding, he may need some more medical helps. Few important steps involved in feeding are reaching to the food, cutting, lifting, bringing it to mouth etc. So please know, assessor ask a professional what is the problem in this inability to feed oneself.
Now let’s say, a person has good coordination, but unable to cut the food, or unable to lift the food, the utensils are heavy, their grip is loose, etc then we can provide some feeding assistance that can help them. Below are the few examples of the adaptive equipment that can be used to assist feeding.
Adaptive equipment for feeding examples:
Built up utensils:
These are good options for people with poor grasp, hand weakness, and poor sensations. These utensils also serve a good alternative for people with arthritis and tremors.
These utensils are heavier to hold and so helps the people with tremors. So a person with Parkinson’s or arthritis or other neurological condition can use these utensils.
People who can’t grip utensils effectively have issues with tremors, or with affected wrist movement, may need this kind of utensils.
This is useful in patients with no wrist or finger movements or severe weakness.
Scooped Plates and Bowl:
As the name suggests, the plates and bowls are scooped which prevent spillage. It also makes scooping the food out of the plate or bowl easier.
This helps to organize the food in a different section. This plate, not only makes the food more organized but also reduce the feeling of overwhelming or “where to start” in patients suffering from many neurological conditions.
This controls the amount of liquid that goes in the mouth and thus, makes drinking safer.
This can be used for warm or hot beverages in people with impaired sensation.
Bright color Plates :
This can help people with some vision impairments. Bright color or patterned plates or bowls may be easier to locate by a person with a impaired depth perception.
Having a person in the upright position for feeding is a must. Also, having food closer to it is easier to reach, table close enough to a person makes a patient’s meal much smoother helps.
These are the basic adaptive equipment that can help with feeding independence. You may have noticed that many of this equipment or utensils are used or prescribed for children as well. And really, they are the same equipment and pretty much does the same function just for a different population.
There are also some specialty machines available to help with feeding. It can help a person is unable to reach the food or have issues with elbow or shoulder range of motion. Some of these examples are the iEAT robot or obi robot that can feed a person with complete no range of motion in arms. These are an expensive machine and honestly takes some time to get used to it.
This is just a general guide to help a person with feeding difficulties keep his or her independence.