[Dysphagia] RE: Dysphagia Digest, Vol 23, Issue 15

[lschmidt at jamestownhospital.com (Lonna.Schmidt)]

<I work with a man who has profound mental retardation.  He uses his hands to wheel his wheelchair, holds a garden hose for about 20 seconds to water plants (his job) but tends to hold it longer (2 minutes or more) to spray other people, and grabs at other people to play with their arms or pull their hair.  When he is sitting at rest, he holds his hands under the opposite side underarm area.  He loves chocolate and sweets, but refuses to use his hands to pick up finger foods.  He will holler, turn his head away, and pull his hands back to refuse.  Yet, when the same food is offered to him from the fingers of a staff member, he happily accepts it.  He also refuses to hold a drinking cup, but enjoys chocolate milk.  Beverages must be given after the meal is completed, by his preference.  If you give him a drink at any time earlier in the meal, he refuses to eat any more of the meal.  
I'd like to support this man's independence in eating but am not sure what to do or if this is even a realistic goal.
What would be a starting point with him?
Thank you.>


I have worked many years with adult DD and have found it possible to retrain behavior as you are questioning.  It takes a modified behavior plan completed at every meal starting with tolerance to touching the item using a cueing hierarchy.  Do you have access to an OT?  The one I worked with was wonderful with this sort of behavior.  Good luck.  
Lonna