Chewing reflex
I have
been thinking a lot about the chewing, and naturally also the salivating that
takes place with some of my clients, before the food actually gets to the mouth,
the action of starting to chew at the very thought, or at the sight of, food.
Does
anyone have anything to share about this? How it is overcome?
My
client and I have always worked hard on this. We are overcoming it but it is a long road as he says.
My
client is a young adult who eats in a café or restaurant now and again, who
eats his midday meal with a group of colleagues at work and who eats other meals
at home with five or six family members.
When he
was younger we would practise at some meal times with a mirror in front of him,
and then sometimes without it, to see how he managed at other times. We often
reintroduce this method as it always brings positive results.
Mirror, mirror on the
table
The
mirror helps him to concentrate his thoughts on himself and not to be
distracted by the chatter of his three siblings’, or the discussions of his
parents. It also encourages him to control the movement of his mouth, his jaw
and lips, to keep his lips closed while chewing and his mouth shut when
collecting more food with his fingers or on a fork or spoon. He also uses the
mirror also to check the position of his head and the movement of his hand,
fork or spoon to his mouth.
He has learnt
over the years to open his mouth only to put the food in it and to chew with
his lips closed. He can prevent the reflexive chewing that still starts as soon
as he thinks about eating something. This produces too much saliva that pours
out of his open mouth when he looks at his plate, if he allows it too. It is a
great achievement for him to have achieved all of this considering the severity
of his athetoid movements, but it is incredibly hard work for him to do it
always.
Coughing, spluttering
and hiccupping
This
client has also learnt that the sudden, reflex coughing fits that occur after
eating are controllable by closing his mouth and breathing deeply, much in the
same way as we can all control coughing when we sit in a full lecture hall or a
classical concert and feel the need to cough, by swallowing, stretching our
bodies and breathing consciously and deeply.
With
learning to control hand movements to stop jerks, and shakes, he can also
control the amount of liquid that he drinks, control the size of the gulps and
therefore the amount of air that he takes in. A recent realisation that he in
fact tries to suck the liquid into his mouth rather than sipping it has
resulted in reduced air intake, less spluttering and fewer instances of the
hiccups.
Peaceful meals
We are
all, family, colleagues and conductors, extremely pleased with this young man’s
progress and hope for many quiet and peaceful mealtimes in the family and elsewhere,
when conversation flows without explosive interruptions from my client and
without someone having to constantly speak to him with reminders of how to do
things.
It is
great when this is how it is and in a restaurant my client usually does
extremely well to concentrate to get it right. This is especially impressive to
see in a new and strange environment that could be off-putting, but instead the
presence of strangers is a great influence and motivation for him. My client
stops producing excess saliva because he stops unnecessary chewing motions, he
prevents the spluttering coughs that spray the table with saliva by practising
his learnt breathing technique. He
prevents dribbling by lifting his head often not producing saliva in excess by
chewing with an empty mouth. He prevents unpleasant sucking noises produced
from his mouth by pressing his lips together and opening them to take in food at
the very last minute.
Blending into the
background
My
client is a bit of a performer, someone who likes to be the centre of
attention. This often has a negative influence on his behaviour and has often
been the reason why in the past he has been noisy and messy at the table, thus
receiving negative attention.
Something
that is very important to his siblings, and of course his parents and any
friends present, is that as my client learns new skills at the table and learns
how to move carefully and quietly in strange places, so that they no longer
feel that their table in a restaurant is the centre of attention, with gazes
averted from, or attracted towards, them and their brother.
Such festive
occasions can now pass harmoniously, fun can be had by all and everyone can
return home relaxed.
Preventing a commotion
Practising being the quietest,
least noticeable person in the room
Things do
not always work out like my client would like them to. When at work or around
the kitchen table at home concentration lapses can mean a big mess and lots of
commotion, and lots of eyes on him!
At work
the group leader has organised a rotation of supervision so there is always
someone there to remind my client, and any others who need help, to check their
manners and eating habits, and to encourage acceptable social behaviour. My
client learns the importance of helping to produce a positive working
environment.
When I
am working with my client in his home we all insist on the same level of
cleanliness and behaviour that we see is possible in other situations. We work
hard on keeping his concentration on his own personal space and actions when he
is eating and he knows that if he wants to listen to or participate in the
discussion around the table then he has to stop eating that is until he has
learnt to do both at once!
It
takes an awful lot of effort and concentration to stop that chewing reflex that
produces so much unwanted saliva. It takes an awful lot of concentration to
keep his head lifted so that the saliva drains away down his throat and not out
of his mouth. It takes a lot of concentration to remember to swallow and breathe
instead of coughing, and it takes a lot of control of movement to be quiet and
help build a pleasant, relaxed atmosphere for all.
Setting expectations
But my
client knows that if he wants to lead an active life, if he wants to socialise
with people outside his close family unit, and even strangers, he needs to be
able to behave in a way that is acceptable in this day and age. He realises
that some sudden movements produce anxiety in strangers, and they move away
from him. He knows that sudden turns in the street, stepping backwards to
regain his balance can cause danger to himself or harm others, especially
vulnerable older people or children. He does his best to control his movements,
and also his grimaces, as he wishes for an active life in the outside world.
We
often talk about how acceptable social behaviour changes from generation to
generation. We have thought that it is perhaps in a way unfortunate that he is
not living in the age when people ate their meat from the bone, wiped their
hands on their sleeves and threw the rest under the table for the dogs.
On the
other hand, he is not living in the age of white table clothes and napkins, and
elbows glued to the sides, that I grew up in! And he has learnt many new skills
because of the restriction that society place on all of us.
My
client is doing well and, considering that he was a late starter in independent
social life, first going out independently when he was eighteen, he is learning
as fast as children who start going to school alone when they are six or seven
years old.
I suspect
that many people’s expectations for those
like my client, who have athetoid cerebral palsy, would not have been set so
high as his have been. As one of four children the expectations for him have
always been set high, both those expectations that he sets for himself and
those set for him by his family, especially
those set by his siblings.
As a
conductor I put some order into these expectations. I set them into our programmes
so my client can achieve them all at some stage in his life, one or two steps
at a time.
