Positioning during feeding

1. INCORPORATING
PROPER
POSITIONING
DURING FEEDING
Final Project – EDSE 669
Ruby Grandison-Abdullahi
George Mason University
December 7, 2005

2. ABOUT MORGAN
 Age: 10 years old
 Placement: Self-contained classroom for students
with severe disabilities
 Mode of mobility: Ambulatory
 Method of Communication: Makes vocalizations like
a soft hum, and turns head from side to side. Claps
when excited and cries when upset. Morgan is able
to hit a voice-activated switch when prompted.
 Diagnosis: Chromosomal disorder
(Inverted duplication of Chromosome 8p11.2-p23)

3. Region p11.2-
p23

4. Significant characteristics of
Chromosome 8p duplication
 Mental and growth retardation
 Aplasia of corpus callosum: incomplete
development of the corpus callosum (a
mass of fibers connecting to the brain’s
hemispheres.)
 Orthopedic problems like scoliosis, and
joint contractures leading to permanent
deformities.
 Highly arched cleft palate

5. Characteristics, continued
 Mandibular prognathism: The
mouth and jaw are projected
beyond the upper face.
 Bifid uvula: The small, fleshy
process hanging down the soft
palate above the back of the tongue
is divided into 2 equal parts by a
cleft.

6. Morgan’s Eating History
 Morgan has always had difficulty eating.
 At school, she eats school lunches that
have been pureed in a small blender to a
semi-lumpy consistency.
 She can eat noodles that are chopped
very fine.
 At home, she eats yogurt, eggs,
applesauce, potatoes and other soft
foods.

7. Eating History, continued
 Morgan also has difficulty drinking from
a cup.
 She shows no interest in having a cup in
front of her, or touching a cup. She
pushes it away whenever a cup is
introduced.
 She takes liquids by mouth with a regular
spoon. Most liquids are added to food.
(i.e. milk added to pudding). Melting
frozen juice drinks have also been
successful for liquid intake.

8. Eating history, continued
 Morgan will grasp a spoon with assistance
and take it to her mouth. She releases
the spoon once the food is eaten off the
spoon.
 She opens her mouth independently to
take food.
 She does not chew, but sucks the food in
her mouth, then swallows it.
 If she does not want the food, she will
gag and eject the food.

9. The Goal:
 To incorporate a proper positioning
plan for Morgan’s feeding times
 Provide oral support
 Provide adaptive seating
 Participate in regular lunch program
in school cafeteria

10. Morgan’s Feeding
Positioning Plan
 Oral and facial stimulation will be
applied initially by O.T. or O.T.
assistant.
 Morgan will walk to cafeteria with
her class.
 She will be placed in an adapted
seat for lunch. (Used also in the
classroom)

11. Feeding Positioning Plan
The Rifton chair
used for seating
provides the needed
support to maintain
her in an upright
position during eating.

12. Benefits of Using Adapted
Seating
 Pelvis can be tilted slightly forward.
 Pelvis can be centered on the back
edge of seat.
 Knees can be flexed to 90°.
 Feet and toes can face forward.
 Trunk can be placed in a
symmetrical position, not curved to
the side.

13. More Benefits of Adapted
Seating
 Positioning of the arms
 Forearms can be relaxed on the tray or on
the armrest of the chair. The present
chair may have to be modified so that
adaptive armrests, (maybe Velcro straps)
can be placed on the tray, since Morgan
often grabs the spoon, the food, or
feeder. This could be faded out as Morgan
adjusts to this positioning, and attempt to
place the spoon in her mouth with or
without assistance.

14. Additional Benefits of
Adapted Seating Position
 Food can be placed on the tray in a
suction bottom bowl to alleviate grabbing,
or spilling of food.
 Feeder can place hand on top of Morgan’s
head to provide head control.
 Additional head support can be provided
by a positioning aid on the back of the
chair, like a head rest, or head strap.

15. Implementation of Plan
 The O.T. will provide training for oral stimulation to
school personnel.
 The P.T. will make the necessary
modifications/adaptations to the Rifton chair so
that it will be more suited for Morgan during
feeding. The specialists will also train individuals on
the proper technique to place Morgan in the chair.
 The O.T. and P.T. will consult with parent and
provide the necessary trainings so that the same
plans are incorporated at home.
 The plan will be implemented initially in the school
cafeteria, then transferred to the home and other
community environments.

16. Collaboration of the Team
 Team Members involved:
 Morgan
 Parents and family
 Special Education Teacher
 Paraprofessional
 O.T.
 P.T.
 Classroom volunteers

17. Collaboration, continued
 Investigate the specific feeding
techniques that have proved to be
successful with Morgan.
 The team should meet and review plan on
an ongoing basis.
 Family should be involved so that the plan
can be implemented at home, so that the
family can enjoy mealtime with Morgan.
 Efforts should be made to ensure that
family has the necessary equipment to
carry out the plan.

18. References
Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes.
Retrieved on December 2, 2005 from http: www.nlm.nih.gov/cgi/
Jablonski/syndrome
Orelove, F., Sobsey, D. & Silberman, R.K. (2004). Educating Children with
Multiple Disabilities – A Collaborative Approach. Baltimore: Paul
H. Brookes Publishing Company.
Snell, M.E., & Brown, F. (2000). Instruction of Students with Severe
Disabilities. Upper Saddle River, NJ: Prentice-Hall, pp. 343-352 &
pp.264-287.