Writing Homework Help

1. First: The ablity level that I think Killian displays according to the Eating and Drinking Ability Classification System may possibly be Level 3 Independent: Eats and drinks with some limitations to safety; there maybe limitations to efficacy. This would be due to the fact that Killian independently feeds herself by spoon and puts it straight into her mouth, however if not monitored she will fill her mouth with large amounts of food (stuffing). Which is not safe and could lead to chocking.  Also, it is reported that she has a limited selection of food she will eat and requires a specific temperature for it to be at. These food aversions, although not reported, may or may not be related to texture, however in thinking about the foods she will eat a bit more, this limited diet will dissolve or soften quickly with saliva and minimal chewing. In addition, Killian will not try different foods which is often common for children diagnosed with DS (Demchak, Nutrition & Eating/Feeding issues). The case file also indicates that children diagnosed with DS, experience a weak suck response during infancy, which could lead to greater problems with establishing the ability to munch. This is supported in the scenario that she sucks on the food rather than chewing (possibly the result of decreased oral and facial muscle tone).  

Second, one variable that should be considered for Killian would be in relation to oral-motor competency during feeding . The scenario mentioned that Killian will suck on her food, rather than chewing it and requires her food to be at room temperature. Chapter 9 of our text (pg 263) describes solid food that is soft chewy that are soft and breaks apart with little pressure. It seems that from the readings, Killian may have not yet developed the ablity to use the munching pattern and is still using the sucking or sucking pattern much like that of a 5 to 6 month old. This could be related to the decreased oral muscle tone, which may also affect her ability to use her tongue efficiently to move food around her mouth. This decrease in oral muscle tone might also effect her ablity to endurance ability and she may tire quickly while eating food that requires a significant amount of chewing and swallowing. 

I’m curious as to all of your ideas and thoughts are in regards to this scenario, as I struggled with deciding which level Killian would best fit into. This also seems like a familiar situation that I’ve worked through in the past with high school aged students with Down Syndrome. We just followed the direction of the OT, PT, & SLP to ensure that the students safely ate and tried new foods.

2. First, Susie is totally dependent (must be fed by others) inviduals that would fall in Level 4:Eats and drinks with significant limitations to safety on the Eating and Drinking Ablity Classification System. She falls into this category as a result of having poor lip closure, poor cheek movement, and poor jaw control (*it is challenging t control the movement of food and fluid the count, to control mouth opening an closure, and to control swallowing, biting, & chewing). In addition, it was reported in the scenario that Jody eats food that dissolves easily with saliva (*eats smooth purees or well mashed food). She gags easily on food that needs to be chewed or on new food, which indicates that she may be swallowing lumps of food whole. The loss of food due to tongue thrust, also is an indicator for this level on the EDAC system. 

Second: One of the many variables that should be considered for Susie would be taking a closer look at how Susie is positioned during meal times. Susie may have better success and less gaging if she was positioned in a way that would provide her body with an opportunity to be more relaxed and less tensed. For example it may be of a greater benefit to have Susie at a slight recline in her travel chair (if she has a tilt-in-space wheelchair), rather than being upright at a 90 degrees. This would provide Susie with the ability to be positioned with a neutral head flexion, neck elongation, and symmetry without the trunk to allow for a less stressful feeding and swallowing meal time activity. (Chapter 9) In addition making sure that Susie is able to have her feet resting comfortably on her foot pedals and  is siting correctly  in her chair (hips, back, legs sitting back & on the seat of the chair) would also be a huge benefit for her to be able to relax during this time. 

3.Hi 

Oral tactile defensiveness defiantly makes sense as a struggle for Susie. What types of activities do you think a OT would suggest for her teacher or parent’s do in order to help her adjust to new sensations?