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Case of Flynn: 4 yrs old w/ refusal to participate in self-feeding…

- - - - Method of Feeding:
      - • Flynn Prefers to finger feed everything so is very messy, and is resistant to utensil use (he will throw it)
      - • Flynn will eat puréed foods from pouches held by an adult or offered on a spoon
      - • He is able to use an open cup but prefers a straw-cup or a 360 cup
      - • Flynn does not like any pureed vegetables and will only eat fruit pouches
      - Caregiver Priority: Mother states her biggest priority is that she would like to see Flynn begin to use utensil's to eat all by himself rather than using his fingers
- - - - Flynn cannot use utensils to self-feed due to low tone and poor active movement in shoulders and cannot support himself sitting on an elevated surface.
      - • At home with his mom, Flynn will work on postural alignment, more specifically, head, neck, and trunk alignment. He will work for better sitting posture while sitting in his chair. Symmetry can be practiced that will encourage Flynn to keep his head in midline and maintain body symmetry. Mother will place Flynn in a raised- supported chair directly across from her in order promote eye contact and communication while keeping his head in midline position.
      - • Because Flynn only eats pureed foods, it is important to work on increasing tone. This will reduce overall postural hypotonicity that accompanies or triggers limiting movement patterns in the jaw, tongue, lips, and cheeks. At home with mom, Flynn will sit on OT's lap with his back supported against chest. OT will then slowly and carefully bounce up and down generating the contraction of the trunk and core muscles that contribute to core stability for Flynn.
      - Flynn has difficulty swallowing and will only swallow pureed foods and therefore is unable to manipulate foods in mouth.
        
        • Because Flynn will only swallow pureed foods, and has not experimented with other food textures, it is important that we work on airway stability. This is done to increase the sustained opening of the pharyngeal airway to support unobstructed respiratory support. OT will place him over a bolster with his trunk elongated to support breathing. OT will gently rock Flynn hoping to loosen any tension he may have in the jaw. OT will then place hand under his jaw and gently jiggle the jaw to reduce thrusting and clenching movements.
        
        • It is important to remember to attempt to keep meal times and the environment as consistent as possible. When attempting to see if Flynn will try other texturized foods, the OT may slowly introduce different portion sizes to him to judge how well his oral motor function is in tact. Then if that is successful, the OT may progress to different textures in moderate, small, portions,
      - Flynn cannot arrange or set-up feeding area to self-feed; relies on mom for feeding
        
        • Because Flynn has UE weakness, perhaps introducing Flynn to a palm strap would be beneficial to him because this will hold the utensil in a secure position in his hand and he will be unable to throw it.
        
        • Flynn will benefit from using a scoop dish that has raised edges as well as providing a nonskid placemat and dish ware that has suction cups to stick on top of the feeding surface. This will help modify his current eating setting so that he can have better physical control over his eating materials, and it will prevent him from throwing this dishes and utensils.
      - Due to poor UE movement, Flynn has difficulty with dressing.
        
        • The OT should consider the environment of his bedroom layout. The OT will work with mom in Flynn’s bedroom to ensure that Flynn can dress as independently as possible. Because he uses a Kaye walker, it is important the OT ensure that there is ample space in his bedroom and lower the dresser drawers so that is provided easy access for Flynn.
        
        Because Flynn has difficulty dressing due to his UE weakness, the OT will assist Flynn in donning his shirt in a gravity eliminated position.