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Toni Talks about PT Today

Please Let My Patients Feed Themselves

Published November 29, 2011 2:39 PM by Toni Patt

Nearly every time I walk down the hall during lunch, I'll see at least one family member feeding a patient. I know the family members mean well. They just want help. Helping someone eat seems to be an obvious way to feel useful. In actuality it does just the opposite. It enables patients to depend on someone else rather than gain independence.

These are stroke patients, not people with chronic, debilitating diseases who lack the necessary motor function. Nor are these patients who become exhausted by the simple act of chewing food. Nope, these are recent stroke survivors who must relearn the art of movement. Repetition increases motor learning. What better way than the repeated movement of hand-to-mouth? It works for teaching compensatory techniques or strengthening muscles.

Food is motivation. Patients need to try. It's one thing if there is a time restriction or visual impairment. I've seen patients with functional UEs sit back and allow a family member to feed them. I had this very discussion this morning with a woman who insisted on feeding her husband. His arms worked just fine. His deficits were balance-related.

Mealtime can also be used as therapy for neglect and inattention. If the food always comes toward the patient from the neglected side, the patient will start to pay attention to that side. For some reason, this concept is very confusing. I repeatedly ask family members to feed neglect patients from the neglected side. As soon as the food comes, everything goes to the non-neglected side because the patient can't see the food from the other side. Sometimes I just want to bang my head on the wall.

There is some evidence that each UE has a specific function during bimanual tasks. One performs the movement. The other stabilizes. Once a UE becomes paretic it can no longer perform that function. The other arm must become mover and stabilizer. Eating provides immediate task feedback and lots of repetitions.

Feeding oneself also provides a sense of accomplishment and independence. That is vital after a stroke. Many stroke patients lose the ability to perform many tasks for themselves. They aren't allowed out of bed to use the toilet. They need help to dress. Being able to eat without assist might be the only thing they accomplish that day. That can't happen if someone feeds them.


You're spot on with your observations and comments. I fear that moving toward a "patient centered" approach, and some of the gross misinterpretations of that, it could get worse.

There have been instances here in the NHS were people were doing exactly as you asked and families accused them of denying the patient food. Talk about an incident report and damage control!

I suppose this will take a cultural shift so that your message is understood and reinforced by all those involved in the rehab process. That means the bureaucrats and policy makers in addition to the clinical professionals.

Dean Metz November 29, 2011 5:18 PM

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