What can be done to improve the mealtime success?
• Sit upright during meals. For MSA in particular, where antecollis is common, support the patient to sit upright against the chair back.
• Eliminate mealtime distractions such as television or conversation.
• Concentrate on maintaining a slow, steady rate of self-feeding or feeding assistance( PSP and CBD). Make sure food or liquid is swallowed before the next bite or sip.
• Keep the plate of food in the line of vision by placing it on a book or other stable object that will provide sufficient elevation( PSP).
• Use a pair of reading glasses instead of bifocals, which are often ineffective in the setting of impaired downward gaze( PSP).
• Experiment with different plates and utensils. Plates with a rim can be useful for keeping food on the plate. Try using a spoon instead of a fork, or a fork with a modified grip, to make it easier to hold.
• Experiment with different cups. Use of straws is not usually advised because the liquid accelerates into the throat, making it more difficult to control. Flexi-cups aid in drinking without tilting the head back.
• Consider a consultation with an occupational or physical therapist to optimize positioning and self-feeding.
Examples of eating and drinking adaptive devices and utensils
• Flexi-Cut Cup • www. alimed. com / flexi-cut-cups. html
• Independence Flo Tumbler • www. kcup. com / flo. htm
• Wedge Cup • www. wedgecup. net
• Provale Cup • www. alimed. com / provale-cup. html
• Maroon Spoons • www. alimed. com / maroon-spoons. html
• Scooper Plate with Non-Skid Base • https:// www. southpaw. com / non-skid-scooper-bowls-and-plates. html
• Skidtrol Non-Skid Bowl • www. maddak. com / skidtrol-nonskid-bowl-p-27963. html
• Bruce Medical Supply • www. brucemedical. com.
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What are some strategies to make it easier and safer to swallow?
• Make sure the mouth and throat are clear of excessive secretions / saliva prior to eating or drinking.
• Maintain the head in a slightly chin-down position while eating, drinking, and taking medications, specifically avoiding extending the head backwards.
• Avoid taking too large a bite, drinking too rapidly, or taking more than one bite at a time.
• Alternate food and liquid swallows to assist with clearance of dry foods or more textured foods.
• Experiment with different food consistencies. Avoid highly textured foods( red meat, raw vegetables, crusty breads, etc.) or dry particulate foods( rice, pretzels, potato chips, crackers, cookies, etc.). Consider changing to soft, moist foods such as casseroles, pasta, canned fruits; or cooked vegetables, fish, and chicken, complemented with gravies, sauces, and condiments.
• Avoid items of mixed consistencies, such as cold cereals, chicken noodle or vegetable soup, and fruit cocktail. These items should be blended into one consistency.
• Thin liquids may be difficult to swallow because they move faster through the mouth and throat. Restrict the amount per swallow or thicken liquids. Information on commercially available thickeners is provided later in this document. Potato or banana flakes, fruit purees, tofu, tapioca, and oatmeal can also be used.