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The Chepstow feeding aid
British Journal 0fPIastic Surgery (1984) 37,407-410 0 1984 The Trustees of British Association of Plastic Surgeons
The Chepstow feeding aid J. FAWKES, M. HUGHES and M. F. GREEN Welsh Regional Centre for Plastic Surgery, Burns and Maxi/lo-facial
Surgery, St Lawrence Hospital, Chepstow
Summary-A specially designed spoon or scoop has been developed to enable controlled amounts of semi-solid food to be accurately and easily inserted into the mouth. This device simplifies feeding following major surgery for intra-oral cancer. Its use and other possible applications are described.
After extensive excision of intra-oral cancer with immediate surgical reconstruction the introduction of solid oral feeding can be difficult. The alteration and limitation of lip closure, associated with
reduced mobility of the tongue (or what is left of it) produce difficulties in initiating swallowing. The patient’s progress from naso-gastric feeding to liquid diets placed intra-orally using a syringe and
Fig. 1
Figure l-(A) The’feeding aid with the “pusher” fully retracted and the scoop empty. (B) The “pusher” has been pressed to its full extent to the end of the scoop. (C) The volume of food that can be held in the scoop is comparatively small and provides a manageable
“bolus”. 407
408
BRITISH
nozzle and then to spoon feeding of semi-solid foods may be dishearteningly slow. It is often a messy and laborious process. Because of continuing problems with swallowing and in particular the difficulty of removing food from the spoon itself, the patients may also find it not easy to return to a normal diet. The spillage of food at meal times may cause.considerable distress to the patient and the family and it was partly to overcome these social and psychological difficulties that the Chepstow feeding aid was invented. It was designed to allow the patient to be able to eat and swallow semi-solid foods without spillage or the use of a syringe and in this way overcome some of the distressing physical, social and psychological effects of eating “en-famille”. In designing the feeding aid the following points were considered:
JOURNAL
OF PLASTIC
SURGERY
0) Spillage from the mouth itself due to poor lip closure (i.e., inadequate lip seal). (ii) Poor or impossible control of food once inside the mouth due to alteration or absence of muscular control of the tongue and lips. (iii) Difficulty in opening the mouth sufficiently wide due to pain, intra-oral swelling or limitation of mandibular movement. (iv) Difficulty in rotation of a conventional spoon due to the diminished size of the intra-oral cavity. The aid takes the form of a scoop not unlike a small garden trowel. Within the tubular metal handle is a pusher device which slides the food forward from the scoop. To allow the nurse or patient to grip the device firmly a piece of rubber
A Fig. 2 Figure 2-(A) Patient in the recovery room immediately after resection of the lower jaw and floor of the mouth with immediate reconstruction using a compound sternal pectoralis major osteo-musculo-cutaneous flap. (B) The same patient 8 days later being instructed in the use of the feeding aid.
409
THE CHEPSTOW FEEDING AID
tubing is slid onto metal handle (Fig. 1 A, B, C). The shape of the scoop and the length of the handle allows food to be deposited at the back of the oral cavity. The scoop has a capacity of approximately half a standard tea spoon and this provides a “safe” and manageable bolus, at least in the early stages of feeding. Because of its ease of insertion and use we have observed very little loss of food due to failure of bi-labial closure and forward thrust of the tongue through the open mouth, so often seen using a conventional spoon. The feeding device is used when a semi-solid diet is introduced into the feeding regime as part of the rehabilitation programme in which the speech therapist and the nursing staff help and encourage the patient and gain his/her confidence. The need for this effort is obvious in the immediate postoperative period when the patient shows understandable lack of interest in food due to the loss of the sense of smell and/or taste, inability to appreciate the texture of food and the inherent fear of choking. Technique The scoop is filled by shovelling up the food from the bowl. It is then inserted into the mouth holding the stem between the thumb and middle finger (Fig. 2). When in the required position the food is slid off the scoop by pressing the pusher with the index finger. The patient very quickly learns to use the spoon himself and this strikingly raises his/her morale and motivation (Fig. 3). It is important that the transition from one form of feeding to another does not lead to a decreased intake and inadequate post-operative nutrition. The fact that the patient can place at least some food into his mouth and feed himself does not let the dietitian “off the hook”. The amount of moisture within the “liquidised” food needs to be varied according to the amount of saliva produced by the patient and food is easier to manage with the scoop if it is not too moist, but rather on the “dry” side. This will help to counteract any excess salivation which may lead to choking. The patient can add cold water with a syringe to alter the texture of the food once it is placed in the mouth if he finds this necessary. It goes without saying that fine-bore naso-gastric drip feeding is maintained to supplement at night any deficiency in the day time intake until efficient bilabial closure and deglutition is established. At this stage, normal conventional cutlery may be introduced.
Fig. 3
Figure 3-The
patient feeding herself.
Observations We have found that with this feeding device patients gain confidence quickly both in controlling the amount of food placed into the mouth and its actual placement. The small amount of food that can be taken at any one time avoids the risk of choking when too large a spoonful is introduced. The spoon is relatively inconspicuous and can be used without social embarrassment at the dining table. Although the feeding aid was originally designed for temporary use to help certain patients after excisional and reconstructive surgery in the head and neck, some patients with long-standing intractable swallowing problems have used the spoon for long periods with benefit. Aniong these are patients with motor neurone disease, cerebral vascular accidents and children with brain damage. The range of size and shape of the “spoon” can obviously be varied and work is in progress to develop a disposable type of feeding device.
410 The feeding the Instrument tal, Chepstow application to
BRITISH JOURNAL OF PLASTIC SURGERY
aid described in this paper is made in Workshop at St Lawrence Hospiand further details are available on the Speech Therapy Department.
The Authors MCST, Senior Speech Therapist, St Lawrence Hospital, Chepstow. M. Hughes, Instrument Technician, St Lawrence Hospital, Chepstow. M. F. Green, FRCS, Consultant Plastic Surgeon, St Lawrence Hospital, Chepstow.
J. Fawkes, LCST, DIP.IPA,
Acknowledgements We wish to thank Mr Mike Christmas and the staff of the Medical Illustration Department for the technical and clinical photographs.
Requests for reprints to: Mrs J. Fawkes, Speech Therapy Department, St Lawrence Hospital, Chepstow, Gwent NP6 5YX.
The Chepstow feeding aid J. FAWKES, M. HUGHES and M. F. GREEN Welsh Regional Centre for Plastic Surgery, Burns and Maxi/lo-facial
Surgery, St Lawrence Hospital, Chepstow
Summary-A specially designed spoon or scoop has been developed to enable controlled amounts of semi-solid food to be accurately and easily inserted into the mouth. This device simplifies feeding following major surgery for intra-oral cancer. Its use and other possible applications are described.
After extensive excision of intra-oral cancer with immediate surgical reconstruction the introduction of solid oral feeding can be difficult. The alteration and limitation of lip closure, associated with
reduced mobility of the tongue (or what is left of it) produce difficulties in initiating swallowing. The patient’s progress from naso-gastric feeding to liquid diets placed intra-orally using a syringe and
Fig. 1
Figure l-(A) The’feeding aid with the “pusher” fully retracted and the scoop empty. (B) The “pusher” has been pressed to its full extent to the end of the scoop. (C) The volume of food that can be held in the scoop is comparatively small and provides a manageable
“bolus”. 407
408
BRITISH
nozzle and then to spoon feeding of semi-solid foods may be dishearteningly slow. It is often a messy and laborious process. Because of continuing problems with swallowing and in particular the difficulty of removing food from the spoon itself, the patients may also find it not easy to return to a normal diet. The spillage of food at meal times may cause.considerable distress to the patient and the family and it was partly to overcome these social and psychological difficulties that the Chepstow feeding aid was invented. It was designed to allow the patient to be able to eat and swallow semi-solid foods without spillage or the use of a syringe and in this way overcome some of the distressing physical, social and psychological effects of eating “en-famille”. In designing the feeding aid the following points were considered:
JOURNAL
OF PLASTIC
SURGERY
0) Spillage from the mouth itself due to poor lip closure (i.e., inadequate lip seal). (ii) Poor or impossible control of food once inside the mouth due to alteration or absence of muscular control of the tongue and lips. (iii) Difficulty in opening the mouth sufficiently wide due to pain, intra-oral swelling or limitation of mandibular movement. (iv) Difficulty in rotation of a conventional spoon due to the diminished size of the intra-oral cavity. The aid takes the form of a scoop not unlike a small garden trowel. Within the tubular metal handle is a pusher device which slides the food forward from the scoop. To allow the nurse or patient to grip the device firmly a piece of rubber
A Fig. 2 Figure 2-(A) Patient in the recovery room immediately after resection of the lower jaw and floor of the mouth with immediate reconstruction using a compound sternal pectoralis major osteo-musculo-cutaneous flap. (B) The same patient 8 days later being instructed in the use of the feeding aid.
409
THE CHEPSTOW FEEDING AID
tubing is slid onto metal handle (Fig. 1 A, B, C). The shape of the scoop and the length of the handle allows food to be deposited at the back of the oral cavity. The scoop has a capacity of approximately half a standard tea spoon and this provides a “safe” and manageable bolus, at least in the early stages of feeding. Because of its ease of insertion and use we have observed very little loss of food due to failure of bi-labial closure and forward thrust of the tongue through the open mouth, so often seen using a conventional spoon. The feeding device is used when a semi-solid diet is introduced into the feeding regime as part of the rehabilitation programme in which the speech therapist and the nursing staff help and encourage the patient and gain his/her confidence. The need for this effort is obvious in the immediate postoperative period when the patient shows understandable lack of interest in food due to the loss of the sense of smell and/or taste, inability to appreciate the texture of food and the inherent fear of choking. Technique The scoop is filled by shovelling up the food from the bowl. It is then inserted into the mouth holding the stem between the thumb and middle finger (Fig. 2). When in the required position the food is slid off the scoop by pressing the pusher with the index finger. The patient very quickly learns to use the spoon himself and this strikingly raises his/her morale and motivation (Fig. 3). It is important that the transition from one form of feeding to another does not lead to a decreased intake and inadequate post-operative nutrition. The fact that the patient can place at least some food into his mouth and feed himself does not let the dietitian “off the hook”. The amount of moisture within the “liquidised” food needs to be varied according to the amount of saliva produced by the patient and food is easier to manage with the scoop if it is not too moist, but rather on the “dry” side. This will help to counteract any excess salivation which may lead to choking. The patient can add cold water with a syringe to alter the texture of the food once it is placed in the mouth if he finds this necessary. It goes without saying that fine-bore naso-gastric drip feeding is maintained to supplement at night any deficiency in the day time intake until efficient bilabial closure and deglutition is established. At this stage, normal conventional cutlery may be introduced.
Fig. 3
Figure 3-The
patient feeding herself.
Observations We have found that with this feeding device patients gain confidence quickly both in controlling the amount of food placed into the mouth and its actual placement. The small amount of food that can be taken at any one time avoids the risk of choking when too large a spoonful is introduced. The spoon is relatively inconspicuous and can be used without social embarrassment at the dining table. Although the feeding aid was originally designed for temporary use to help certain patients after excisional and reconstructive surgery in the head and neck, some patients with long-standing intractable swallowing problems have used the spoon for long periods with benefit. Aniong these are patients with motor neurone disease, cerebral vascular accidents and children with brain damage. The range of size and shape of the “spoon” can obviously be varied and work is in progress to develop a disposable type of feeding device.
410 The feeding the Instrument tal, Chepstow application to
BRITISH JOURNAL OF PLASTIC SURGERY
aid described in this paper is made in Workshop at St Lawrence Hospiand further details are available on the Speech Therapy Department.
The Authors MCST, Senior Speech Therapist, St Lawrence Hospital, Chepstow. M. Hughes, Instrument Technician, St Lawrence Hospital, Chepstow. M. F. Green, FRCS, Consultant Plastic Surgeon, St Lawrence Hospital, Chepstow.
J. Fawkes, LCST, DIP.IPA,
Acknowledgements We wish to thank Mr Mike Christmas and the staff of the Medical Illustration Department for the technical and clinical photographs.
Requests for reprints to: Mrs J. Fawkes, Speech Therapy Department, St Lawrence Hospital, Chepstow, Gwent NP6 5YX.