Education and Training in Developmental Disabilities - Division on ...

Stacy, Participant 5, was a 7-year-old female
with a diagnosis of cerebral palsy. She presented
with a severe physical impairment with
mixed muscle tone. Her level of cognitive
function<strong>in</strong>g was estimated at severe. Stacy had
a PEG tube, with which she was given all liquids,
as well as two tube feed<strong>in</strong>gs per school
day. Accord<strong>in</strong>g to teacher report, oral feed<strong>in</strong>g
had been attempted on a daily basis at school
with variable results.
Stacy’s diet was restricted to pureed consistency
only. Observation, <strong>in</strong>terviews, <strong>and</strong> the
SOMA evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g
characteristics: (a) an open-mouth posture
with spoon<strong>in</strong>g, (b) <strong>in</strong>consistent orientation
to the spoon or the feeder, <strong>and</strong> (c)
<strong>in</strong>consistent open<strong>in</strong>g of the mouth <strong>in</strong> anticipation
of the spoon. See Table 1 for two primary
goals identified for Stacy.
Jessica, Participant 6, was a 4-year-old female
with developmental delays of unknown
orig<strong>in</strong>, a secondary seizure disorder <strong>and</strong> bl<strong>in</strong>dness.
Her level of cognitive function<strong>in</strong>g was
estimated at severe. Jessica’s diet was pureed,
with liquids thickened <strong>and</strong> given through a
“sippy” cup. Jessica was fed <strong>in</strong> a wheel chair
with head supports <strong>and</strong> fed with a soft spoon,
due to an active bite reflex. Results of observation,
<strong>in</strong>terviews, <strong>and</strong> the SOMA evaluation
revealed the follow<strong>in</strong>g feed<strong>in</strong>g characteristics:
(a) m<strong>in</strong>imal lip movements to clean the
spoon, (b) <strong>in</strong>consistent bite reflex, (c) m<strong>in</strong>imal
lateral jaw movements with chew<strong>in</strong>g, <strong>and</strong>
(d) total dependence on the feeder for spoon<strong>in</strong>g,
although she was able to br<strong>in</strong>g h<strong>and</strong>s
toward face <strong>in</strong> other circumstances. Jessica
also exhibited extreme tactile/sensory defensiveness
by pull<strong>in</strong>g away <strong>and</strong>/or cry<strong>in</strong>g, particularly
when touched on the h<strong>and</strong>s, but also
when touched on the face. Two primary goals
were identified for Jessica (see Table 1).
Dust<strong>in</strong>, Participant 7, was an 11-year-old
male diagnosed with cognitive deficits follow<strong>in</strong>g
a severe seizure at birth, as a result of
encephalitis. Dust<strong>in</strong>’s level of cognitive disability
was estimated at severe. He was also identified
as hav<strong>in</strong>g a behavior disorder. Dust<strong>in</strong>
was able to <strong>in</strong>dependently eat a regular diet,
with verbal prompt<strong>in</strong>g to attend to the feed<strong>in</strong>g
task. Observation, <strong>in</strong>terviews, <strong>and</strong> the SOMA
evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g
characteristics: (a) categorical refusal of fruit,
(b) decreased evidence of sensory awareness
as evidenced by no napk<strong>in</strong> use with food on
84 / <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>-March 2005
his lips or face, (c) giggl<strong>in</strong>g <strong>and</strong> self-stimulat<strong>in</strong>g
h<strong>and</strong> flapp<strong>in</strong>g, f<strong>in</strong>ger <strong>in</strong> eye, <strong>and</strong> hair
twirl<strong>in</strong>g movements while eat<strong>in</strong>g, (d) stuff<strong>in</strong>g
his mouth at the beg<strong>in</strong>n<strong>in</strong>g of a meal, but
refus<strong>in</strong>g to eat after a few bites. Two primary
goals were identified for Dust<strong>in</strong> (see Table 1).
Kyle, Participant 8, was a 4-year-old male
with a diagnosis of cerebral palsy <strong>and</strong> associated
physical impairment <strong>and</strong> developmental
delays. His level of cognitive disability was estimated
at severe. Observation, <strong>in</strong>terviews, <strong>and</strong>
SOMA evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g
characteristics: (a) decreased lip closure
to clean the spoon <strong>and</strong> (b) no <strong>in</strong>dependent
use of utensils although he was able to f<strong>in</strong>ger
feed. Two goals were identified for Kyle (see
Table 1).
Anna, Participant 9, was a 13-year-old female
with developmental delays <strong>and</strong> physical
impairment of unknown orig<strong>in</strong>. The level of
her cognitive disability was estimated at severe.
Observation, <strong>in</strong>terviews, <strong>and</strong> the SOMA
evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g
characteristics: (a) marked food preferences
<strong>and</strong> expell<strong>in</strong>g non-preferred foods, (b) complete
reliance on the feeder for spoon<strong>in</strong>g (but
<strong>in</strong>dependent cup use), (c) food spillage from
the lips, (d) apparent sensory defensiveness
with touch to the face evidenced by turn<strong>in</strong>g
rapidly away when her face was wiped, <strong>and</strong> (e)
m<strong>in</strong>imal lateral tongue movements, (f) delayed
oral stages of swallow<strong>in</strong>g. Two primary
goals were identified for Anna (see Table 1).
Methods Used to Determ<strong>in</strong>e Feed<strong>in</strong>g Skill <strong>and</strong>
Mealtime Behavior Goals
Basel<strong>in</strong>e data (Condition A) of feed<strong>in</strong>g skills
<strong>and</strong> mealtime behaviors were collected us<strong>in</strong>g
the SOMA evaluations <strong>and</strong> observations
(Skuse et al., 1995). Basel<strong>in</strong>e probes were conducted
at each participant’s home school,
with the same feeders <strong>and</strong> with<strong>in</strong> the sett<strong>in</strong>g
where they were currently be<strong>in</strong>g fed <strong>and</strong>/or
supervised dur<strong>in</strong>g feed<strong>in</strong>g. The Pr<strong>in</strong>cipal Investigator
(PI), a licensed, certified SLP, conducted
these basel<strong>in</strong>e evaluations. All evaluations
were videotaped to allow for further
analysis by the PI <strong>and</strong> for purposes of calculat<strong>in</strong>g
<strong>in</strong>terrater reliability percentages by an
additional licensed SLP. The additional SLP
viewed all SOMA evaluation videotapes <strong>and</strong>
videotapes of three pre-<strong>in</strong>tervention mealtime
observations. The PI <strong>and</strong> additional SLP <strong>in</strong>di-