ACL 2.0
They can go beyond a soft diet but foods must be cut up into small pieces. Hard to chew and stringy foods should be avoided. Provide opportunities to make food choices (up to three choices) and honor their preferences. Continue to encourage self-feeding with finger foods.
Family and friends often like to bring food when they come to visit. Educating them about safe finger foods is worth the effort because it preserves the person's identity and maintains the connections with loved ones. Families tend to worry about choices and may be reassured to know that repeating one choice over and over again is great. When they find something they enjoy, you should check for medical precautions for food items such as sugar. When in doubt, check with the dietician or the doctor for them.
The seating arrangement needs to provide a stable proximal base for optimum head control and swallowing. A pressure care cushion also protects bony prominences.
You will have to explore variations to find an "easy to hold cup" that different individuals will use. The variations seem to be linked to the individual's procedural memories because different people may or may not accept a handle, a lid or a straw. Their hands usually must be placed on the cup because they do not reach out until ACL 2.8.
The value or importance of self-feeding with hand-over-hand assistance is questionable because their attention to their trunk control fades away. If constant repositioning is required, it is both labor intensive and distracting from nutritional intake. Most nursing assistants choose not to do it because it is not worth the effort. Most family members will not be able to make the constant adjustments for poor trunk control that are essential for swallowing safely with hand-over-hand assistance. If attempted, a scoop dish will make self-feeding easier or use a silicone non-slip placemat.
ACL 2.2 - 2.4
Eating is very slow and they may need two to three times the usual amount of time to eat. Food must be cut up into small pieces without strings because stringy and not chewed lumps are not noticed and choking is a hazard. Verbal encouragement to continue eating is often necessary.
Prevent spills by filling the cup half full.
Be sure that hot foods and liquids have cooled down before placing them in front of the person because they probably will not check them.