Muscle Tone and Positioning

It is important to understand the influences of muscle tone and proper positioning on the ability to eat safely and efficiently in this population. Increased or decreased muscle tone contributes to difficulty preserving a patent airway, compromised self-feeding skills, poor rib cage expansion and esophageal motility, and difficulty in maintaining a stable supported base for seating. Fluctuating muscle tone leads to involuntary movements and limited postural stability. Despite the type of muscle tone, optimal positioning is crucial for feeding and swallowing. The proper feeding position includes neutral alignment of head and neck, midline orientation, symmetrical trunk position, 90° pelvic/femoral alignment, and symmetrical arm position with neutral shoulders. An example of proper positioning can be seen in Figure 7. Consultations with orthopedists and/or rehabilitation physicians to address current and potential musculoskeletal problems, physical and occupational therapists for functional assessment, orthotists for deformity management, and durable medical equipment specialists to customize standard wheelchair components are valuable.

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