IN BRIEF / Heres one I made earlier

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Implications beyond nutritional intake

Christina H. Smith (email christina.smith@ucl.ac.uk), Chris Donlan, Michael Clarke and Penney Edwards develop a functional assessment of chewing.

Heres one I made earlier...

Alison Roberts with a low cost, flexible and fun therapy suggestion for groups Menu game
In a caf I visit, there is a waiter who remembers everyones orders without writing them down. When he returns he unfailingly places each dish in front of the right person. When I asked him how he was able to do this he said that he forms a mental picture of each person eating their chosen meal. In the clinical situation we have tried a similar approach to memory exercises, with good results. The game is all the more motivating because the menu is devised by the group themselves calling on their abilities to think laterally and work cooperatively. It is also a useful activity for those working on independence or life skills. In addition the role-play element can be fun. It is suitable for a group of about 3-4 clients. MATERIALS Menu forms (sample at www.speechmag.com/Members/Extras); Pens; Biscuits (at your discretion) PREPARATION Each group member thinks of 2-3 dishes for each course and jots them down on scrap papers that are then pooled. (Its a good idea to do this part anonymously.) On examination of the types of food chosen the group decides together whether the hypothetical eating-place is an upmarket restaurant, or inclines more towards the Greasy Spoon end of the market, and whether you are going to offer two or three courses. Once you have arrived at a reasonable range of dishes you can write the list down on some of the forms. At this point you may like to stop, and do the ordering part at the next session. IN PRACTICE Begin by telling the group that memorising the list of orders will be much easier if they associate a face with a meal. Take turns to be the waiter and hand out the completed menus. The other players each request their starter and the waiter repeats each persons order immediately, and then repeats the whole group order. If the waiter feels able, he then repeats the process with the main course, and if really confident will repeat the whole groups starter and main course. Now the waiter goes out of the room, and then returns with as many plates as he can mime carrying! He then mimes placing each dish in front of the correct customer, stating what the dish actually is. He waits for a moment before miming clearing the table, exiting the room again, and coming back with the main courses, stating what they are as he places them, as before. The dessert will be the last part of his task, and is carried out in the same way. You might decide to have different waiters for each course if the activity seems to be too difficult, or if others are keen to have their go. You might want to offer biscuits to the group after all that talk of food! VARIATIONS This is well received by 18s and over instead of a caf with its food menu and waiter, you can conjure up a pub, with a list of possible drinks and a person buying a round. Each member requests a drink, and the person buying must remember which consumer requested which drink. Add peanuts and different flavours of crisps and you will have an excellent - and useful - memory game. Younger children could have a beach caf with ice creams and soft drinks.

espite having a normal diet, considerable variation exists in the chewing ability of children with physical disabilities. These children may have an adequate or good pharyngeal swallow, but nevertheless have oral preparatory difficulties which make mealtimes slow and stressful for them and their families. In order to establish a better understanding of chewing ability in children with motor disabilities we have developed and tested an innovative, simple and reliable clinical research tool utilising chewing gum. The chewing gum is composed of two different colours which are mixed in the process of chewing. Chewing ability is characterised by an analysis of: (i) how well the two different colours were mixed together, indicating ability to manipulate a bolus and mix saliva into a bolus, and (ii) how well the bolus was shaped ready to be swallowed. Assessments, including evaluations of the consistency of the gum, carried out by speech and language therapists who were blinded as to the participants, has shown the procedure to have excellent reliability. This work involved typically developing children and children with a clinical description of cerebral palsy aged between 5 and 16 years. All children ate a normal consistency diet. Perhaps unsurprisingly, differences were observed in both the ability to manipulate the bolus, and in the ability to prepare it for swallowing between these two groups, with typically developing children performing better in both cases. Chewing ability was not related to severity of cerebral palsy nor was it related to sub-groupings of cerebral palsy (that is, athetoid, spastic and so forth). For example, a child with relatively severe cerebral palsy performed equally well in chewing ability as someone with mild cerebral palsy and vice versa. Both groups improved in their performance across all parameters with increasing age, but the differences between the groups remained. We were working with two groups of children who eat a normal consistency diet; the group with cerebral palsy do not therefore have the most severe oromotor difficulties. However, the differences in their oromotor abilities, reflecting the skills required for oral preparation of a food bolus, are significant. This suggests that not only are we seeing hidden variability in this population, but also that this tool is sensitive to small differences in ability. We would anticipate that the differences this tool reveals will have implications for quality of life, stress and family wellbeing within this group of children with cerebral palsy. We may extend the use of the gum to look at oro-motor skills more generally. We aim to develop the gum for clinical assessment and for the gum to be used as an objective baseline measurement which could be repeated as required and provide a functional outcome to enhance our evidence based practice. This work suggests that a proportion of children that present with relatively mild cerebral palsy and have a normal diet still experience significant difficulties with chewing and preparing food for swallowing. This is likely to have implications beyond their nutrital intake, for example, their attitude towards mealtimes, and stress around mealtimes. Clinicians should be wary of assuming that a normal diet represents a non-problematic situation.

Further reading Davis, E., Shelly, A., Waters, E., Boyd, R., Cook, K. & Davern, M. (2009) The impact of caring for a child with cerebral palsy: quality of life for mothers and fathers, Child: Care, Health and Development 36, pp.6373. Edwards, P. (2002) Bolus preparation in children with cerebral palsy using chewing gum: a comparison with normal children. MSc Thesis, UCL, London. Liedberg, B. & wall, B. (1995) Oral bolus kneading and shaping measured with chewing gum, Dysphagia 10, pp.101-106.

SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2010

Reprinted from www.speechmag.com

Ref. Roberts, A. (2010) Heres one I made earlier: Menu game, Speech & Language Therapy in Practice Autumn, p.7. (You can use the name of your nearest or school/college cafe instead.)

The Chattoria
Snacks
Sandwiches egg and cress; tuna mayo; ham; cheeses and pickle - 2 Sausage rolls - or vegetarian sausage rolls- 1.50

Soups all at 2.50, served with a roll

Tomato Pea and Ham Chicken noodle

Main Courses all at 3.50 served with salad

Spaghetti Bolognaise Sausage and chips Fish and chips Vegetarian quiche Pizza

Desserts all at 2.00

Ice cream (several flavours available, just ask) Chocolate gateau Crme brulee Fruit salad Apple pie Cheese and biscuits

Beverages
Coffees - 1.50 Teas - 1.00 Herb teas - 1.25 Soft drinks Coke, Lemonade, J2O, Appletize - prices on request Other drinks to order from the bar