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Flynn- Feeding Intervention Plan Screen Shot 2019-07-14 at 12.33.08 PM…

- - - - Flynn is fed orally in a chair for 3 meals and 2 snacks daily and takes longer to eat due to fatigue from his myotonic dystrophy. He requires encouragement to feed and refuses to use utensils unless they are being used by his mother to feed him. When using utensils, Flynn will throw them out of frustration and continue eating with his preferred method of feeding: finger feeding. Flynn is able to use an open cup to drink but prefers a straw cup or a 360 cup. Flynn's Micrognathia causes occasional drooling. When spoon feeding, chewing, and cup drinking, his lips are mature, while his tongue and jaw are immature. Flynn has good bolus control, but has slow posterior transport.
- - - - Approach: Modify
        
        Type: Preparatory Methods-AT
        A feeder chair with a tray will be provided to Flynn to promote postural alignment and stability when feeding. Flynn will use this chair for every meal to obtain upright posture and support for his upper extremities. Proper alignment of the pelvis and trunk can facilitate easier movement in the UE's and head for optimal feeding.
        (Case-Smith & O'Brien, 2015)
      - Approach: Establish/Restore
        
        Type: Activity
        Flynn will engage in a play activity with a prone scooter to stimulate muscles of posture and increase tone. He will lay prone on the scooter and use his arms to ambulate to various toys placed around the room. He will also do this activity seated on the scooter using his legs to push himself around.
        (Case-Smith & O'Brien, 2015)
        
        Grade Down: place the toys closer together if this activity is too fatiguing
        
        Grade Up: the addition of toys and placing them further apart will make this activity more difficult on the muscles and more fatiguing
    - - Approach: Modify
        
        Type: Preparatory Methods-AT
        Flynn will use a spoon with a thick grip during mealtime. A larger grip will be easier to manipulate and can help improve fine motor skills. Flynn will use this spoon for every meal.
        (Case-Smith & O'Brien, 2015)
        
        Grade Down: use a lighter spoon with an even larger grip for easier grasp and manipulation
        
        Grade Up: use a smaller grip or remove the grip altogether to make the skills required harder
      - Approach: Establish/Restore
        
        Type: Activity
        Flynn will participate in a play activity involving a modified spoon (larger grip) and sand. He will use this spoon to scoop up sand and place it in a small bucket. After the sand is in the bucket, Flynn can dump it out and use a pencil-like stick to draw in the sand. This will improve his fine motor skills.
        (Case-Smith & O'Brien, 2015)
    - - Approach: Modify
        
        Type: Preparatory Methods-AT
        A communication board will be created using velcro and pictures. In coordination with this family, Flynn's board will contain pictures of common foods he enjoys eating. This board will also contain pictures relating to other ADLs and have one word responses, like yes and no. Flynn can use this device to point at the pictures he wishes to communicate. Once his fine motor skills improve, a transition back to the tablet will be done to allow for verbal communication from the device.
        (Case-Smith & O'Brien, 2015)
        
        Grade Up: More pictures and words can be added for a broader range of communication. Transition to the tablet can also be done when Flynn is ready.
        
        Grade Down: Fewer pictures can be placed on the board for easier selection
      - Approach: Prevent
        
        Type: Education
        Education provided to Flynn's family members regarding the importance of effective communication will be done. Behavioral problems can root due to lack of effective communication. The family will learn effective ways to communicate with Flynn and ways to support Flynn's communication.
        (Case-Smith & O'Brien, 2015)
  - - - Approach: Establish/Restore
        
        Type: Activity
        Flynn will engage in a feeding activity using backward chaining. He will begin by using his eating utensil for a small portion of the time. With each session, Flynn's time using the utensils will increase. This will be aimed at discouraging the refusal behavior. Positive reinforcement and cheering will be provided to Flynn when he is actively using the utensil to encourage utensil use in self-feeding.
        (Case-Smith & O'Brien, 2015)
      - Approach: Establish/Restore
        
        Type: Activity
        A self-feeding schedule will be developed including a reward system. Flynn will have to self-feed with a utensil for 10 minutes of his total mealtime. For every successful 10 minutes, Flynn will be rewarded with playtime involving a game/toy of his choice. The schedule will consider Flynn's frequent fatigue. Positive reinforcement can help improve motivation and decrease bad behavior.
        (Case-Smith & O'Brien, 2015)
        
        Grade Down: the 10 minutes can be reduced for a shorter self-feeding time to accommodate for his fatigue
        
        Grade Up: self-feeding time can be increased, making the reward harder to obtain