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Wednesday, September 23, 2020

Feeding – physical therapy treatment aspects

Feeding activities represent indulging all primary needs for water and energy-providing compounds. Feeding a neurological patient is often difficult or impractical and can lead to complications with food and liquids aspiration, even choking. Problems of feeding in neurological physical therapy are viewed from a larger perspective, other than basic life need for food.

Feeding a neurological patient can be observed from several aspects, depending on estimation of patient’s problem structure. We estimate patient’s ability to prepare meals, bring food, serve it, and organize it. In treating this feeding aspect, patient is directed to recognize food types and organize, recognize, and use adequate food plates. Along with motoric abilities, accent is put on perceptive and conscious component of feeding. Patient’s abilities to chew and swallow are estimated. Orofacial treatment of facial muscles, tongue, chewing and swallowing muscles is conducted. Depending on the problem, treatment facilitation can be stimulating or inhibiting.

The treatment is based on re-enabling automatic motorics of chewing and swallowing. Postural position of feeding is estimated – patient’s most optimal position must be assessed. It is vital to choose the surroundings well.

Best postural conditions include a non-limiting seating position at the dining room table, or some other room adequate for feeding. Seating position providing free body movement is important for abilities of normal chewing and swallowing. Inability to stay upright, falling forwards, or stiffness is problematic for normal chewing and swallowing. Patients who experience problems with postural adaptation must be ensured proper balance activities, and adaptation of surroundings.

Proper chairs should be used, or invalid chairs, pillows, or sponge mats to support the body while seating. Abilities of functional using of upper limbs inn feeding are estimated. For normal feeding activity bilateral activity of both hands is necessary. Selective hand mobility is required, hand and finger fine grip, and balance of movement coordination with visual control.

Therapeutical approach to these problems includes stimulation and facilitation of movement components which are disabled or limited. Patient must learn the most optimal way to feed through using those abilities that remain normal (controlled optimal functional compensation).

Using adapted food sets is the least popular answer, but it is also a possibility for those patients who have no potential for a more normal feeding procedure. Feeding is an important activity in patient’s resocialization. Other than being a basic human need, feeding also has a social component, and brings pleasure and comfort. Patients with feeding problems are often unable to smell and taste food, and are frustrated with problems in seating balance, chewing, swallowing, and using food accessories. Feeding in lying down or some other improper position is especially uncomfortable. Those patients will feel unease when eating with other family members. Eating out, or with a larger group of people, can be a big psychological issue.  Avoiding it enhances the patient’s handicap and lowers the level of resocialization after the damage in central nervous system.

Understanding, analyzing, and estimating the problem will help with solving it adequately. Importance and complexity of this problem needs multidisciplinary estimation and treatment in accordance with expertise of rehabilitation team members. Patient’s family or caretakers also need to be educated about the feeding problems and ways to integrate this activity in everyday life. 

Adequate approach and treatment conducted by all team members can significantly reduce this handicap, and even solve it permanently.

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