Meet Carlos: Who are we concerned about?
Carlos a two year-old boy, has recently demonstrated interest in feeding himself using a spoon. He spends his days at an in-home daycare with three other children ranging in age form one to four. His daycare providers report that Carlos appears to be motivated by the other children to feed him. He enjoys a variety of foods that are appropriate to eat with a spoon including applesauce, mashed potatoes, and oatmeal. Carlos has a diagnosis of cerebral palsy and is limited in how he can use his arms and hands. Carlos is able to hold a utensil in his hand for brief periods once it is placed there. However, increased muscle stiffness makes it difficult for him to get a spoon accurately into his mouth. Additionally, Carlos has difficulty using two hands together and can not stabilize a bowl or plate with one hand while scooping with the other. Per the daycare provider’s report Carlos often knocks the bowl off of his tray while attempting to scoop food.
Consider and Trial AT
Goals: What is it we want this student to be able to do?
Currently, the daycare provider feeds Carlos much of his meal and then allows him to self-feed a small portion. She reports that he would prefer to feed himself his entire meal, but she does not have the time to sit with him when she needs to also attend to the other children. The family and daycare provider are looking for solutions to improve Carlos’ ability to spoon feed himself independently.
Tools & Strategies How can we support this student to achieve the goals?
In this case because Carlos has difficulty with the range of motion for his arms and hands, stabilizing his bowl as he eats and accuracy in getting the food into his mouth. His family and the daycare providers decided to try adapted plates and utensils that would support his feeding. There are several different types of dinnerware that is made out of break resistant materials with rimmed plates and bowls designed for complete mealtime independence. The adapted utensils that considered included a clip-on utensil that extends the utensil to provide a larger area to grasp, a built-up handle utensil that offers a bicycle-type handle, weighted handles, comfort grip handles or swivel utensils. The swivel utensil keeps utensil level when wrist movement is restricted or coordination is poor. Carlos also has difficulty using two hands together and cannot stabilize a bowl or plate with one hand while scooping with the other. Dycem place mats can help stabilize the bowl or plate and provide greater support for Carlos. Many of these products can be located in www.maxiaids.com.
Implement AT
How will we ensure that new tools and strategies are effectively used?
The daycare staff and family were trained to implement the new utensils with Carlos. They spent time at home and at daycare trying the the utensils and plates/bowls with Carlos. After trying several plates and utensils a rimmed plate and bowl and a spoon with a bent, built up and weighted handle were determined to be the most effective. Carlos also did better when Dycem was placed under the plate or bowl. When Carlos is fatigued staff and family take over in the feeding, but there is a goal to increase the amount of the meal that he self feeds. Seeing Carlos’s pride in being able to “do it myself” was very rewarding for both the family and the staff. There is still a concern at daycare about the time it takes for Carlos to self feed, especially since naptime needs to occur in the daycare shortly after the 30 minute lunch time.
Monitor Progress
How do we know the student is on track?
As Carlos gained more independence and skill with the adapted utensils, he was able to feed himself more quickly. There are still times that the family or the daycare provider help him, however this is decreasing. The daycare is trying to wean their support and allow Carlos the time to work on feeding himself by starting to feed him a few minutes earlier than the other children start lunch.
