Toward More Refined Self-Feeding Skills

One of my middle-school students really enjoys her friends--telling jokes, hanging out in the hallways, sharing "insider" info about TV and movie stars.  She's known these friends since late elementary school and feels very comfortable around them.

However, there is one time of the day when she doesn't feel so comfortable and that's lunch time.  Because of difficulties with allover motor coordination, including oral motor, her table area, clothes and face end up covered with stuck-on food and numerous spills.  Her friends have started sometimes eating without her because they are pretty grossed out by the food coming out of her mouth at unexpected times and the spills that end up on their clothes, even on their food.  It may not be a reflection of "true" friendship, but it's reality among pre-teens to strive to hang out with others who draw attention to the group because of their "cool" factor and not because they look different.

As for me, I think about how her difficulties with managing food affect her now and in the future.  She will probably participate in vocational settings while still in high school and then work for pay after high school is completed.  Will her co-workers sit with her in the employee lunchroom or will they avoid her?  Will she miss out on conversations around the water cooler because co-workers avoid looking at her crumb-strewn face?  Sound harsh?  Of course.

Yesterday during her lunch the student, "Zoey," her instructional assistant and I found a quiet kitchen at her school and opened up her lunch box.  My intro to her was that, just for today, we were going to experiment with having her enjoy all her food without losing any.  We were going to keep the table area clean so that we didn't have to spend time sweeping the floor afterwards.  She was going to have a clean face at the end of the meal so she wouldn't have to spend time going to the washroom to towel off her face.

I taped a 3' wide swatch of bulletin board paper to the table, using a dark color so any crumbs could be easily seen.  We focused on eating the nutritious foods first--her chicken sandwich and fruit.  To save time, I cut her chicken into 1" square pieces and asked her to use a fork instead of her fingers.  She said she wasn't crazy about eating the bread so we left it.

I asked her to chew one piece of meat at a time.  After swallowing it I asked her to drink a sip or two of water and then asked if her mouth felt empty.  If it didn't feel empty I asked her to drink more water.  Same for her orange mini sections.  Even though they were juicy I still asked her to drink water after swallowing the food.  She only had time for two bites of potato chips--one at a time-- followed by water.

At the end of lunch I asked her if her mouth felt clean/empty--yes.  She had no crumbs on her mouth or anywhere on her face.  There was no food on the floor and a minimal amount on the "placemat."



Food packages removed--water spills and few crumbs evident.  Floor clean.

She didn't need to wipe her face or get a broom and dustpan to sweep the floor.  She just packed up her leftovers and went on to her next class.

This session answered my questions: could she manage food within her mouth without losing it, simply by slowing down her quantity and pace of food intake--yes.  Does sipping water aid in keeping the food from being trapped within her mouth--yes.  Does she demonstrate any coughing or choking during the meal--no.

I estimate that Zoey can become independent in managing food within her mouth, following these guidelines for reduced food intake per bite and using water to clear her mouth, if she practices for about 1-2 school years and also practices daily at home.  She has spent 14 years practicing what she currently does during mealtimes and snacks; it will take a lot of practice to change her accustomed habits.  Her IEP meeting is this week--I will ask her team if they think better oral management is important.  Zoey and her family will be at the meeting.

Do you remember that I told Zoey that we were doing the experiment "just for today?"  That's true.  It may end up being a one-time thing.  She has to feel it's important and so does her family.  If she wants to work toward more refined self-feeding habits it will require a lot of effort and time from her and on the part of school staff and her family.

Adapted Mother's Day Card

Although Mother's Day won't be for another week I swooped up this card today, created by the stationers at one of my high schools.  These students in a program for students with autism have been making and selling seasonal cards during this school year, to practice fine motor, decision-making, sequence following and entrepreneurship!

An "adapted" card?  Well, it was originally designed for a mom of a human child and I needed it to reflect a mom of a sweet puppy.  So--just add one more custom cut-out; easy-peasy.

As time goes on I find out about more and more classes for students in special education who use in-school businesses to learn and practice academic and vocational skills--making artisan soaps, sugar scrubs, fancy coffees, potato bars, wreaths, dog grooming.  What about your schools?

Cooking Up Some Trail Mix for Special Olympics

In a week or two these highschoolers are going to be hungry and thirsty during a day of Special Olympics in RVA.  After scouring the grocery shelves for ingredients that had not been processed/packaged in a plant also processing tree or ground nuts--whew!--we decided on these yummy ingredients:

Hey, no judging!  It's all about the energy.

Students practiced scooping various volumes of dry ingredients, or spooning a few raisins into their labeled baggies.

My speech and language pathologist group co-leader insisted on well-formed sentences and use of key verbs.  Hardly any opportunity to pop a few Cocoa Puffs into your mouth when you're so busy talking!

"The Sound of a Tree Falling"

During my second cup of kaffee this morning I heard Garrison Keiller read this poem,

http://writersalmanac.org/     (be sure you're looking at today's date--April 22nd)

and it reminded me of students whose sensitivities to sound prevent them from fully concentrating on a task, or even relaxing when they're dead tired.

Hope ya'll have a relaxing, quiet weekend.  Or, a wild and noisy one if that's your sensory preference!

Recycling through the Generations--a family tradition

Kudos to one of our OTs on staff--Susan Custer.  Her story in the Richmond Times-Dispatch:

http://www.richmond.com/life/article_ed2462b0-90c1-52fe-8cd6-ee410118b78c.html

was originally published on 4-11-2016 and soon featured on ABC news.

http://abcnews.go.com/US/cherished-family-tuxedo-handed-generations-proms-weddings/story?id=38340592

Way to go, Susan!

Theraband as Foot Fidget

We tried this fidget idea in a classroom for high schoolers with mild cognitive disabilities and it's working pretty well for one guy who likes to run in short spurts around the room and keep active while he's learning.  He still needs verbal reminders to use the band to get his feet a-movin', but sometimes it helps him stay at his desk a little longer so he can get more work done.

Here's a brief video of his feet in action--  https://youtu.be/yADLlCh4Jno

Update 5-5-2016:  Visiting the classroom this morning I learned from his teacher that he has recently begun using the foot fidget more frequently and it seems to help with focusing on in-class work--Yippee!

At the Movies

This story is difficult to write, since it hits close to home and to the people I care about, but here goes.

Uncle Grumpy and I were sitting in one of those tiny movie theaters, waiting for the matinee to begin. It was quite pleasant, almost roomy, having the place practically to ourselves, although more and more folks trickled in during the interminable wait to finish the ads and promotions that bog down the enjoyment of the theater experience these days. Hmph! We were there to see an action-packed thriller and I had my comfy earplugs ready in my coat pocket, to make sure I could still hear the birds singing when the movie was finished.

I noticed a young woman walk in and find a seat across the aisle from us, but a little closer to the screen. Although I wouldn’t go to the movies alone I have friends who do, so I didn’t think it was strange to see her sitting by herself. As she settled in I noticed that she carefully straightened her sweater, pulling her sleeves down after she removed her coat, and smoothed the front of her long skirt.

Uncle Grumpy couldn’t wait any longer for his popcorn fix and left for the concession stand. I made sure his jacket was draped across the entire seat of his chair, so no creepy person would try and sit next to me; I must have thought I was 25 again. Looking around I noticed that the young woman who had just sat near us was pulling her sleeves snugly down to her wrists and tugging her skirt down to cover her ankles—no, now she was standing up to tuck her thin sweater into her waistband. Following this, she worked on her sleeves and smoothed the fabric on her skirt from her hips to her knees. This happened three more times before the movie began.

During the quiet parts of the movie the young woman held her elbows in her hands. When the loud action scenes were happening she partially stood and re-tucked her sweater, then smoothed her skirt. At times she gently pulled on her eyelashes. This continued throughout the whole movie. It was all I could do not to cry through the blood-and-guts thriller we came to see, because part of my heart was breaking for this beautiful girl who had no rest from her behavior.

Uncle Grumpy and I walked out of the theatre into the cool, starry night. When we got in the car he turned to me and said, “What was that all about?”

I looked at him, this confident, can-do man who rants at world events every morning when he reads his websites but faithfully shows up to tutor little kids whose first language isn’t the one he speaks. Looking down at his fingers, bleeding or mending from his incessant picking, I wondered what to say to him that would make sense. “She couldn’t help doing those things, she has to do them or she will feel terrible. If she took enough medicine to keep her from doing those things I wonder if she would be awake enough to enjoy the movie.” Of course, I had no way of knowing if what I said about the medicine was true but I felt it was okay to potentially exaggerate to make a point.

The drive home was a little somber and my heart was heavy throughout the evening. I’m used to ritualistic behavior in the students I work with in special education. The never-ending, anxious questions, the need to carry certain objects throughout the day, the confusion and, sometimes, outbursts when there is an unexpected change in the daily schedule. But, tonight, this happened outside of work, away from the people I know who understand how to help people with a variety of disorders. It happened in the other part of my life, the “normal” part.

Before bed that night I made sure the doors were locked, the windows closed and there were no skinny, creepy people behind my couch or bedroom door. Uncle Grumpy was softly snoring and he looked like a little cowboy angel, tucked snugly in his blanket, hands at rest. I got into bed and arranged my covers just so, not too tight on my toesies and just high enough on my neck. The floor fan was on for just the right amount of white noise and I turned to face the door, so I could react instantly if any bad guys burst in the room.

But my thoughts were not so quiet that night, thinking about the woman at the movies, my work, my family and myself. I just want to know, where are all the normal people?