Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

May 2012 Independent Eating and Drinking Newsletter

	May Topics: Why the Mealtime Partner is the Best Powered Dining Device Ever Built (Part 2) Summertime and Adequate Hydration
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Why the Mealtime Partner is the Best Powered Dining Device Ever Built (Part 2)

The first part of this article was published in last month’s Newsletter. It provided information about why specific features of the Mealtime Partner Dining Device were part of its overall design. The original concept for the Mealtime Partner began at The Arc of the United States. The Arc is an organization that serves the needs of people with intellectual and developmental disabilities. Because the constituents that The Arc represents have intellectual disabilities, a primary focus of developing a dining device was to make it intellectually accessible, as well as physical accessible. To that end, features were included in the device design that made the device easy and intuitive to use. Last month User Access to the Equipment was discussed but it only addressed issues of physical access to the equipment. To begin the second part of this article, intellectual access will be described because it is of equal importance to device access as physical access is and was an integral part of the overall design.

User intellectual access to the equipment. It is important to place the least cognitive load possible on an individual who has intellectual disabilities when they are accessing assistive technology. This allows the user to be able to use the equipment without confusion or a struggle to master its operation. If they are able to learn how to use the equipment, they can enjoy the experience of being independent. To make this possible for Mealtime Partner users, the following design features were incorporated.

The Mealtime Partner bowls are transparent. This permits the user to easily view the contents of each bowl during the meal so that they will know what foods are being offered.

Because the device is positioned for use at the same level as the user’s mouth as shown in figure 1, below, all of motions that the device make are within the user’s immediate view. Therefore, as the bowls rotate from food option to food option, the user can see through and into the bowl that is close to them and decide if they want a bite of the food that is in that bowl. The other two bowls are out of their direct line of sight, and, therefore, are not a distraction from the food that is available. They can decide if the food immediately in front of them is what they want to eat, or move on to another choice. The rotation of the bowls is smooth (no jerking) and very quiet and does not trigger involuntary reflexes. When a food choice has been made, the spoon dips into the bowl and scoops up a spoonful of food from the bowl. Once food is on the spoon, the spoon extends out from the bowl and presents the food on the spoon close to the user’s mouth. As with the bowl movement, the spoon movement is smooth and quiet, reducing the likelihood of inducing a startle reflex.

Figure 1 - Boy Taking Bite from the Mealtime Partner

Once the spoon has extended out from the bowl for the user to take a bite, the time that it remains extended can be adjusted. For some people it can take several seconds to process what they should do next, before they decide to move their mouth onto the spoon and take a bite. Also, for those who have oral motor coordination limits, the spoon may need to remain extended to facilitate their being able to produce lip closure once they have moved their mouth onto the spoon. These features allow the Mealtime Partner to be very patient and not hurry the user.

It is not uncommon for individuals who have always been fed to not understand that they must take food from the spoon once it is offered, as they have always had someone insert the spoon into their mouth and lift the spoon to remove the food from it by wiping it against the user’s upper teeth. If a spoonful of food is offered to them, they have not learned the concept of actively participating in taking food from the spoon. Normally, verbal prompting will quickly resolve this lack of understanding, particularly if a high-preference food is offered while they are learning. The Mealtime Partner Control Panel has a “Pause” button on it. When it is pressed the action of the device is put on hold. For those who do not understand the concept of taking food from a spoon with their mouth, once the spoon has extended out from the bowl, the Pause button can be pressed. This keeps the spoon extended until the Pause button is pressed for a second time. This feature allows time for the user to be instructed about how to take a bite off of the spoon. They do not need to be hurried, and can practice without concern that the spoon will go away too soon. After using the Pause button for a few bites, the concept will be learned and it will no longer be necessary to use the button.

Control of the amount of food on the spoon. Earlier dining devices sometimes picked up a whole serving of mashed potatoes (if they were a little too dry) in one spoonful. With dense, sticky food (like mashed potatoes sometimes can become), when the spoon comes in contact with the food, the whole serving sometimes sticks to it. Often, a big clump of food on the top, bottom, and sides of the spoon was served to the user to eat. Other times, the food would drop off of the spoon prior to reaching the user’s mouth simply due to its weight.

On the other hand, even more likely was no food being picked up by the spoon and an empty spoon would be presented to the user. And, the likelihood of this, increased as food on the plate is reduced throughout the meal. For this reason alone, many people using earlier devices would soon reject using “a feeder”, basically abandoning the device for manual feeding because when you are hungry it is frustrating to be served an empty spoonful.

This problem was solved in the Mealtime Partner design. First, the bowls are shaped to continually bring the food back into the spoon sweep area. Secondly, to control the amount of food on the spoon, three different Bowl Covers are available with the Mealtime Partner. They quickly and easily snap onto the bowls to control the amount of food served for each spoonful. Low, medium and high wiping edges are available for the covers, and depending upon which cover that is installed on the bowl, the volume of food on the spoon will vary accordingly. And, lastly, the bottom of the spoon is wiped by the bowl, so excess food will fall back into the bowl.

Three different Bowl Covers, serve three different amounts of food.

Keeping foods separated. To provide a “normal” appearance, a plate was used in the earlier devices from which to serve food. To select food the spoon must move around the plate. In some instances the plate rotated, in others, the spoon simply swept through the food. In either case the result was that the food on the plate gets mixed together. In many cases, foods that complement each other in a meal do not taste good if they are mixed together. Additionally, food that is mixed together is visually very unappealing. Fundamentally, users did not like their food being mixed by a machine. To solve this problem, the Mealtime Partner uses three bowls to contain the food separately. Additional bowls can be quickly and easily installed on the device, for the more hearty appetites. And, these custom made bowls can be put in the microwave oven to heat the food initially or to warm up food that has cooled.

Speed at which the device moves. Because the early devices were designed with a specific user in mind, the speed at which they operated was not variable. Thus, when another person used the device, they found that it operated too fast or too slow. An additional problem that existed was that the movement patterns of devices made gross movements to get the spoon from the plate to the user’s mouth. This large movement tended to be jerky and for individuals who have a startle reflex, it was a trigger for an involuntary reflex.

To avoid this problem, the Mealtime Partner has a wide range of speed settings, operating methods, and other options that are made available through a simple graphics display located on the top of the device. Additionally, the movement patterns of the device are smooth and compact, and unlikely to cause a startle reflex.

User control over the device operation. Another major problem that existed in the earlier dining device designs was the lack of flexibility in how the user controlled operation of the device. Powered devices were provided with their own custom switches that the user had to accommodate. This problem was resolved in the Mealtime Partner design by using a common interface, making it compatible with all of commercially available adaptive switches. (There are many different adaptive switches available commercially that provide for a wide range of user needs.) In addition, the Mealtime Partner can be controlled without any switches in a fully automatically mode; by one adaptive switch in a semi-automatic mode; or using two adaptive switches for total control of the spoon (to control when food is served), and the bowls (to select which food is served).

The various devices that were analyzed in the development of the design for the Mealtime Partner Dining System are no longer available. However, a few newcomers to the market place have been developed. Most of these devices are not available in the United States. None of the newcomers have addressed user access in their design and thus still remain inaccessible to most people who would like to use them because they must sit on a table for use. Additionally, many of the problems described above still remain within their designs.

User Safety. Safety was always the highest priority in the development of the Mealtime Partner and it was designed with careful consideration of the wide variety of intellectual and physical characteristics of its potential users. To minimize any physical risks to the user, multiple design considerations were utilized to reduce the possibility of injury. First, the Mealtime Partner is specifically designed such that the spoon extension mechanism is very low force and operates for a very brief time (around 1.25 seconds). If the spoon strikes an object, it will stop. Furthermore, the spoon extension mechanism will not resist externally applied pressure and is easily pushed back into the Mealtime Partner body. This is comparable to the way a caregiver’s arm would move if the person they were feeding leaned too far into the spoon.

Next, the Mealtime Partner can rotate on the shaft to which it is attached to the Support Arm, or Support Shaft, and will rotate away from the user if pressure is applied. If mounted on legs, the Mealtime will slide away when pushed.

For additional safety, the Mealtime Partner’s spoon is made with flexible, non-breakable plastic to further guard against injuring the user. All parts of the Mealtime Partner that contact food (i.e., the bowls, bowl covers and spoon) are made of a high quality polycarbonate plastic that is FDA approved for use with wet and dry food. (They are also dishwasher and microwave oven safe.) There are no potentially harmful electrical voltages used in the Mealtime Partner. The Mealtime Partner always operates from the battery, even if it is connected to the external AC power source used for charging the battery. (It does not charge the battery when the Mealtime Partner is operating.)

The Mealtime Partner is the only dining system that is viable for use by the vast majority of people who are unable to feed themselves. This is because great effort was made to include features that provide access to a broad range of users. In 2012, the Mealtime Partner Dining System is still a unique product that is unmatched in the world of powered dining equipment.

 

Did You Know? Did you know that more than half of Americans have one or more allergies (according to the National Institutes of Health). Many different items can cause an allergic reaction including food, food additives, animals, dust, pollen, plants, mold and insects. Even water can cause a rash in very rare cases (called aquagenic urticaria). 150 to 200 deaths occur in the United States each year as a result of an allergic reaction to food. The most common food items that cause allergic reactions are cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish, and tree nuts. Once a food allergy is identified the food should be avoided. Over 2 million people are allergic to insect stings; many of them have severe reactions with 50 to 150 deaths from stings occurring each year. Insect stings result in up to a million hospital visits per year. Cats are the most common pet to cause allergies and no breed of cat is less likely to cause a reaction than another (despite the claims that hypoallergenic cats have been bread). It is extremely important to know if a person who is unable to eat independently has allergies to avoid the person feeding them giving them something that they should not eat!

 

Summertime and Adequate Hydration

As warmer weather becomes the norm, it is time to think about providing adequate hydration for everyone. When exercising, one must remember to drink sufficient fluids to avoid dehydration. Children playing should have plenty of water. (Even when swimming, it is easy to sweat enough to get under hydrated!) The problem of dehydration is more significant in the summer. This is especially true for those who are unable to get a drink independently. For example, children in school, when they go to the bathroom, are usually given an opportunity to get a drink of water from the water fountain. If a child is unable to reach or drink from a water fountain other provisions must be made for them to have a drink. However, frequently this need is overlooked for those who cannot drink by themselves.

The effect on a person of not having enough fluids is gradual. Everyone thinks of being thirsty as the indicator that it is time for a drink. However, by the time thirst is experienced, the body is already beginning to dehydrate. That is why it is important to drink frequently and regularly. If thirst is experienced and adequate fluids are not consumed at that time, other symptoms will be experienced. A headache is commonly the next indicator to be experienced after thirst and it will be accompanied by a general feeling of malaise. Once these signs occur the individual’s disposition will be impacted. They can become drowsy and irritable.

Lack of adequate fluids has a very serious impact upon people with disabilities. For those who are affected by spasticity it can become more pronounced when the individual is dehydrated. For everyone, but especially those who have intellectual disabilities, clear thinking becomes difficult if not impossible. The list of consequences of dehydration is extensive and more information about the importance of hydration can be found in our November 2009 Newsletter, and our February 2012 Newsletter.

Being able to drink independently at any time that you choose is a challenge for many people who have limited hand and arm control. However, there are several drinking systems that make “hands-free” drinking possible. They can be mounted on a wheelchair, bed, or table. The following is a brief description of the hands-free drinking systems available from Mealtime Partners, Inc.

The Hydration Backpack with Drinking Tube Positioning mounts on the back of a wheelchair using the backpack shoulder straps to attach it to the wheelchair handles. The Drinking Tube is attached to one of the wheelchair handles with a clamp and the tube can be positioned to meet the individual’s need. The user will then have liquid available to them all of the time. More information about this drinking system can be found in the February 2012 Newsletter.

The Front Mounted Drinking System can be attached to any of the tubing of a wheelchair. It allows a cup holder to be positioned in front of the user and the Cup Holder can accommodate many different containers including a bottle, insulated coffee mug, a Sippy cup, a can of soda, etc. A straw should be inserted into the container and the user is then able to drink from the container without using their hands. This system has the advantage of accommodating regular length straws that require less suction than a extra long straws (like the drink tubes provided with many drinking systems). Also, disposable straws can be used making this the easiest drinking system to keep clean and sanitary. More detailed information about the Front Mounted Drinking System (including many pictures) can be found in our January 2012 Newsletter.

The Hospital Bed Hydration System meets the hydration needs of those who are unable to lift or hold a cup while they are in hospital. It mounts to the plastic bed rails of the newer hospital beds and allows a drinking tube to be positioned close to the patient’s mouth. This is the only hands-free drinking system available for hospital beds. More information about this drinking system can be found at our website under Drinking.

Lastly, the Drink-Aide system consists of a cup holder that attaches to the handle of a wheelchair and a drinking bottle that fits into the cup holder. The bottle has a drinking tube that is contained in flexible conduit that allows the end of the tube to be positioned close to the user’s mouth. Drinking (at our website) will also provide further information about this drinking system.

Regardless of the drinking system that is used it is always important to remember the hydration needs of individuals who cannot independently access a drink. If you would like help in selecting a drinking system for a specific person and are not sure which one would be best for them, please call 800-996-8607, or email us at drinking@mealtimepartners.com and we will be pleased to assist you.

 

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