FEEDING ATTACHMENTS, FEEDING CUP AND METHODS OF USE

Abstract

The invention relates to a feeding attachment for a feeding cup for feeding a patient with feeding difficulties. The feeding cup including a cup body for containing thickened liquid food a wall, and an exit channel. The feeding attachment includes an attachment means for removably attaching to the exit channel and a body for receipt of the thickened liquid food, via the exit channel. A control means, for control of the thickened liquid food from the exit channel is also included. In this way thickened liquid food may enter the body of the feeding attachment from the exit channel, as controlled by the control means, and the patient may take the thickened liquid food from the body of the feeding attachment without hyperextension of the neck. The invention also relates to the cup and feeding attachment together and methods of use.

Claims

1-19. (canceled)

20. A feeding cup attachment including: a body with a proximal end and a distal end, the body having a substantially spoon shaped portion with a bowl and peripheral rim, the body being adapted to permit contents of within the bowl to be taken by a patient off the distal end, and wherein the rim substantially at the distal end substantially lies within a spoon plane and the proximal-most portion of the rim projects from the spoon plane so as to define a holding cuff proximal of the bowl; attachment means at the proximal end of the body, the attachment means including a tube therethrough terminating at an open end into the bowl, and the attachment means being adapted to attach the feeding cup attachment to a feeding cup with cooperating cup attachment means; and a valve arrangement within the tube adapted to control the flow of a fluid within the tube; the feeding cup attachment being adapted in use to be selectively tiltable though a tilt plane substantially orthogonal to the spoon plane between one configuration where a fluid in the bowl may be poured off the distal end of the body and in another configuration the fluid in the bowl is retained within the holding cuff.

21. The feeding cup attachment of claim 20, wherein the holding cuff when the spoon plane is tilted towards the vertical defines a volume greater than a fluid holding volume of the bowl when the spoon plane is horizontal.

22. The feeding cup attachment of claim 20, wherein the attachment means defines an attachment axis substantially coaxial with the elongate axis of the tube, and the attachment axis distends proximally from the spoon plane by substantially 45 to 65 degrees and so thereby adapted to attach with a cup attachment means projecting at substantially 25 to 45 to the vertical.

23. The feeding cup attachment according of claim 20, wherein the holding cuff is expandable such that in use it may expand as a result of fluid held therein.

24. The feeding cup attachment according of claim 20, wherein the valve arrangement includes a one-way valve that allows fluid to flow to the bowl but prevents or resists back flow such that in use the valve arrangement is adapted to allow fluid to flow into the bowl and prevent or slow back flow from the bowl.

25. The feeding cup attachment of claim 20, wherein the valve arrangement regulates the flow of fluid therethrough.

26. The feeding cup attachment of claim 20, wherein the attachment means is removably attachable to the cup attachment means.

27. A feeding cup and feeding cup attachment wherein the combination includes: the feeding cup attachment of claim 20; and a feeding cup including a cup body, cup attachment means and a fluid exit associated with the cup attachment means.

28. The feeding cup and the feeding attachment of claim 27, wherein the cup attachment means projects from a side of the cup body substantially at a base of the feeding cup.

29. The feeding cup and the feeding cup attachment of claim 27, wherein the cup attachment means is substantially at 25 to 45 degrees to the vertical when the base is horizontal.

30. The feeding cup and the feeding cup attachment of claim 27, wherein the fluid exit is tubular that at one end projects from a side of the cup body near a base of the feeding cup and the cup attachment means is at the other end of the fluid exit.

31. The feeding cup and the feeding cup attachment of claim 30, wherein the fluid exit projects at substantially 25 to 45 degrees to the vertical when the base is horizontal.

32. The feeding cup and the feeding cup attachment of claim 30, wherein the fluid exit is curved along its length.

33. The feeding cup and the feeding cup attachment of claim 30, wherein the fluid exit has a transverse cross-sectional dimension of at least 20 millimetres.

34. The feeding cup and the feeding cup attachment of claim 27, wherein the feeding cup attachment and feeding cup are attached together.

35. A method of feeding patients with the feeding cup attachment of claim 20 including: filling the feeding cup with thickened liquid food; attaching the feeding cup attachment to the feeding cup; tilting the feeding cup to cause the liquid food to flow into the bowl; and feeding a patient by the patient sipping or sucking the liquid food from the bowl and off the distal end of the feeding attachment.

36. The method of claim 35, wherein the method is part of a stepped program of options used to feed patients with different grades of dysphagia, including early stage and intermediate stage.

37. The method of claim 35, wherein the thickened liquid food is of a standardised thickness chosen from the group: Level 150, mildly thick where fluid flows but will coat a spoon; Level 400, moderately thick, would drop off a spoon in dollops, rather than running; and Level 900, extremely thick, where there is no flow and the liquid food would remain on a tilted spoon.

38. The method of claim 35, wherein a seated patient may be fed without hyperextension of their neck.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0138] The invention will now be described in connection with non-limiting preferred embodiments with reference to the accompanying drawings, in which:

[0139] FIG. 1 is PRIOR ART, the feeding cup of the inventor subject of Australian patent application number 2016202017, used with the feeding attachments described herein;

[0140] FIG. 2 is a perspective view from above of a feeding cup and feeding attachment according to a first preferred embodiment of the invention;

[0141] FIG. 3 is side view of the feeding cup and feeding attachment of FIG. 2 as viewed when the cup is on a flat surface, illustrating how the holding cuff can hold the volume from the spoon-part in this position;

[0142] FIG. 4 is a side view of the feeding cup and feeding attachment of FIGS. 2 and 3, tilted as to feed a patient, with the volume in the spoon-part;

[0143] FIG. 5 is a cross-sectional side view of the feeding cup and feeding attachment of FIGS. 2 and 3, flat on a surface;

[0144] FIG. 6 is a cross-sectional side view of the feeding cup and feeding attachment of FIG. 4, tilted to feed a patient;

[0145] FIG. 7 is a rear perspective view of the feeding cup and feeding attachment of FIGS. 2, 3 and 5, flat on a surface, illustrating the holding cuff arrangement;

[0146] FIG. 8 is a detailed side view of the feeding attachment of FIGS. 2 to 7 illustrating the spoon-part and cuff;

[0147] FIG. 9 is a cross-sectional side view of the feeding attachment of FIG. 8;

[0148] FIG. 10 is a perspective view from above of a feeding cup and feeding attachment according to a second preferred embodiment of the invention;

[0149] FIG. 11 is a detailed side view of the feeding attachment of the second preferred embodiment of FIG. 10;

[0150] FIG. 12 is cross-sectional side view of the feeding attachment of FIG. 11;

[0151] FIG. 13 is a detailed side view of a valve used with the feeding attachment of FIGS. 10 to 12 with the ball valve closed;

[0152] FIG. 14 is a detailed side view of the valve of FIG. 13 with the ball-valve open;

[0153] FIG. 15 is a cross-sectional perspective view of the feeding cup of FIG. 10 showing the valve of FIGS. 13 and 14 installed in the exit channel, and the ring stopper to prevent loss of the ball;

[0154] FIG. 16 is a cross-sectional side view of the feeding cup of FIG. 15, illustrating the closed ball valve;

[0155] FIG. 17 is a detailed plan view of the a cusp valve part of the valve arrangement of FIGS. 10 to 16;

[0156] FIG. 18 is detailed side view of the cusp valve part of FIG. 17;

[0157] FIG. 19 is a detailed perspective view of the cusp valve part of the valve arrangement of FIGS. 17 and 18;

[0158] FIG. 20 is a cross-sectional perspective view of a feeding cup with the cusp valve part of FIGS. 17 to 19 installed; and

[0159] FIG. 21 is a cross-sectional view of the feeding cup of FIG. 20 in a tilted position.

DETAILED DESCRIPTION OF THE INVENTION INCLUDING A BEST MODE

[0160] Referring to the inventors prior art multi-angle feeding cup of Australian patent application number 2016202017, as illustrated in FIG. 1, multi-angle feeding cup 1, has body 10 and exit channel 12. Exit channel 12 has flexible mouth piece 14 attached with hole 16 to feed thickened liquid food to a patient; the patient, and thickened liquid food is omitted throughout all the Figures, for ease of illustration. The thickened liquid food products are proprietary products of the inventor, sold under the brand NutriTaste (Trade Mark). Use of the proprietary NutriTaste (Trade Mark) is of particular benefit with the invention, and have been developed to work together. Other products could be used instead.

[0161] Exit channel 12 is joined at cuff 18 to mouth piece 14 to enable ready removal and interchange of mouth piece 14. Mouth piece 14 is attached with a slot-and-groove arrangement with a triangular connection to cuff 18.

[0162] Lid 20 with label 22, and handles 24, 26, 28, and join of 14 to 12 to complete cup 1 to create a fully multi-angle feeding cup that may be inverted and liquid food does not fall out, but can be fed through hole 16 in a safe and controlled manner. In this manner the positional angle of feeding may be any suitable angle, a great benefit when feeding patients. Body 10, exit channel 12, cuff 18 and lid 20 of multi-angle feeding cup 1 are all illustrated made of a rigid plastics material, namely Acrylonitrile Butadiene Styrene (ABS) to be strong and resistant to damage.

[0163] Mouth piece 14 is made of a soft silicone, rating 47 on the Shore hardness scale, as has been found particularly suitable. Mouth piece 14, enables feeding of thickened liquid food to an adult using the seek, suck and swallow reflex.

[0164] Mouth piece 14 also includes bulb 32, having a suitable thickness of material, as well as the correct size and shape to fit the potential space between the central tongue and hard palate of an average adult mouth. In an elderly patient the tongue may fatigue easily if bulb 32 and other parts of mouth piece 12 are made of a material too strongly resistant. If the material bulb 32 is too soft then there is insufficient propulsion. A firm and effective recoil of bulb 32 is used so that bulb 32 refills with thickened liquid after suction and deposit of the material has occurred. After extensive experimentation, bulb 32 was found to have optimal function where the wall is 1.8 millimetres thick silicone with a shore hardness value of 47. All of mouth piece 14 is made of silicone of this form, and varies only in shape and thickness of wall, for example, the walls at the hole being arranged to create a valve.

[0165] Once bulb 32 of mouth piece 14 is in the mouth of the patient it is compressed by the tongue against the hard palate to increase bulb pressure, which is beneficial during feeding. Shaped part 34 of mouth piece 14 is designed to fit and wedge the anterior aspect of the tongue, in use, to assist to feed the patient in a safe, comfortable and efficient manner. Hole 16 at the low pressure end of bulb 32, loses integrity due to thinner walled prolapsing cusps, to facilitate the controlled deposit of the thickened liquid food to the back of the tongue of the patient.

[0166] As illustrated mouth piece 14 is coloured green, indicating that hole 16 has a diameter of 0.5 millimetres and is suitable for mildly thick liquids, Level 150. Alternative mouth pieces 14 are also supplied, colour coded to make it quick and easy to find an appropriate mouth piece 14 to use with the particular thickness of liquid. Where mouth piece 14 is purple silicone, this indicates that hole 16 has a diameter of 1 millimetres and is suitable for moderately thick liquids, Level 400. Similarly, where mouth piece 14 is blue, this indicates that hole 16 has a diameter of 2 millimetres and is suitable for extremely thick liquids, Level 900. Clearly, these colours can be varied, and different manners of indicating the type of mouth piece 14 used instead. These colours have been adopted by Australian Standards as standardised with the levels of thickness to facilitate the correct use by carers.

[0167] Handles 24, 26, and 28 run from base 42, towards lid 20, to allow comfortable and easy holding. Base 42 is a flat, stable base ensuring maximum stabilisation of cup 1 when placed on a surface to minimise accidental tipping over.

[0168] Use of multiple handles 24, 26 and 28 gives more options to hold cup 1, in every direction. The patient may hold handles 24 and 26, for example, and the carer may keep a light hold on handle 28 in care of loss of grip or to assist with tilting. The carer may hold any one of handles 24, 26 or 28 or more if convenient in order to feed the patient at any angle or position.

[0169] Pressure hole 36 is included in lid 20, to relieve pressure that may be created in body 10 of cup 1, in the usual fashion.

[0170] A speech therapist, dietician or other health care professional may prescribe use of a particular level of thickness of food and so the associated mouth piece 14. Introduction of standardised systems and formulas in this regard assist to follow through on these prescriptions for the best feeding outcome for the patient.

[0171] Premix formulas provided by the inventor's company or others are intended to be adjusted to comply with the three levels of thickness and the three mouth piece 14 configurations. A colour co-ordinated approach to the packaging for the premix makes the system simpler again, and for the instructions for the particular thickness. For example, 50 grams of a premix formula of Level 2 mixed with 250 millilitres of water should exactly suit the standardised thickness level of Level 2, Level 400 moderately thick. In this way, the premixed liquid food Level 400, should comply perfectly with use of the inventive multi-angle cup 1, with purple mouth piece 14, having hole 16 with a 1 millimetre diameter. In another example, 50 grams of a premix formula of Level 1 mixed with 250 millilitres of water should exactly suit the standardised thickness level of Level 1, Level 150 mildly thick and so would be used with green mouth piece 14 having hole 16 with 0.5 millimetre diameter. Likewise blue mouth piece 14 would be used where the premix formula is made up according to the instructions to level 3, Level 900 extremely thick. Clearly, the instructions, proportions and colours can be varied.

[0172] Use of a standardised safety protocol (the Safety Protocol) directly before feeding the patient is most preferred and will proceed as follows: [0173] Step 1: Professional prescription of use of suitable mouth piece size and premix at the thickness level desired; [0174] Step 2: Selection of the appropriate mouth piece 14 and premix; these are colour coded and coordinated for quick and easy selection; [0175] Step 3: Mix and shake 50 grams of premix in a shaker with 250 millimetres of water for 30 seconds until smooth and well mixed; [0176] Step 4: Pour mixed thickened liquid food mixture into body 10 of cup 1; [0177] Step 5: Seal by screwing on lid; Step 6: Fit appropriate size of mouth piece 14 by screwing on cuff 18; [0178] Step 7: Tip cup 1 so mouth piece 14 is pointing vertically down over a receptacle for a few seconds so that the liquid food enters exit channel 12; [0179] Step 8: Observe for 10 seconds to ensure that no liquid exits hole 16; [0180] Step 9: Milk mouth piece 14 by pulling between two fingers in a downward motion to expel the content of mouth piece 14 onto the plate while in the downward orientation; and [0181] Step 10: Observe for a further 10 seconds to ensure that no further liquid exits hole 16.

[0182] As described fluid flow is strictly controlled so that only on the milking of mouth piece 14 will fluid flow and no dribbling or dripping should occur once the milking action has ceased. The milking action, in use, is caused by use of the seek, suck and swallow reflex elicited in the patient. It is most beneficial that the flow is so precisely controlled, so that it can be stopped immediately, if need be, without additional flow. In this, the prior art cup and feeding attachment is adapted to carefully control the flow and volume for safe feeding.

[0183] The following describes alternative feeding attachments that have been developed for use to improve the feeding outcome for a particular patient. For example, where the patient is assessed as having early or intermediate dysphagia, rather than a more advanced grade.

[0184] Referring to FIGS. 2 to 9, a first preferred embodiment of the invention will be described, where feeding cup 1 is the feeding cup of the prior art of FIG. 1, with a different, inventive feeding attachment used. The reference numerals used for feeding cup 1 are the same as used to describe FIG. 1. These reference numerals to the feeding cup are the same for each of the embodiments. To reiterate, feeding cup 1 has body 10 and exit channel 12. It is to and about exit channel 12 that the inventive feeding attachment is attached for use for early stage dysphagia as described in more detail below. Mouthpiece 14 and cuff 18 are replaced in the new form of the invention. However, label 22, handles 24, 26 and 28 are included, as is base 42, and grips 44, 46 and 48. The description for these is as described for FIG. 1. It is preferably to use the ergonomic and carefully designed feeding cup and exit channel of the earlier invention as shown in FIG. 1, with the inventive feeding attachment of FIG. 2. However, in inferior forms of the invention the feeding cup may be different, having a single handle for example. The attachment of the feeding attachment is a screw fit between the upper most part of exit channel 12 and feeding attachment 64, as would be readily understood by a person skilled in the art.

[0185] Feeding attachment 64 has spoon part 66 and neck 68. The overall shape of the spoon part is suitable to be used by a patient as a spoon but has numerous design aspects to enable a patient with early stage dysphagia to safely use and feed from the apparatus.

[0186] The spoon like shape is more acceptable to patients with early stage dysphagia and so is a good introduction to use of the feeding cup. Opening 70 enables the thickened liquid food to be fed without the hyperextension of the neck, which can be a serious problem in these patients.

[0187] As can be seen in particular in FIG. 8, the internal mechanism of inventive feeding attachment 64 has been carefully designed to provide a vastly improved means of feeding those with early stage dysphagia. Spoon part 66, of feeding attachment 64, has tip 72, bowl 74 and floor 76 for receipt of thickened liquid food from exit channel 12. Wall 78 provides some control over the flow with flow enabled through curved slit 80 to assist in flow management as described below. Without some degree of control, free flow of the thickened liquid food would make feeding difficult, and lead to spillage and mess. Corresponding sides 82 and 84 are also shown in FIG. 8 as part of the screw fit to exit channel 12. A push fit or other means to readily attach and detach feeding attachment 64 could be used instead. The attachment is firm once in place so that feeding can take place confidently.

[0188] As mentioned above, drinking out of a normal cup imposes the problem of high-risk neck extension for the patient with dysphagia. The patient has to extend the neck to empty the cup, particularly difficult if drinking thickened liquid foods, and towards the bottom of the cup. The subject invention introduces the use of a feeding attachment 64, to exit channel 12 of the Rose-Cup (Trade Mark) cup 1. The spoon like attachment enables a patient with early stages of dysphagia to use a spoon-method of feeding thickened fluids in a constant drinking action, importantly without extending the neck. The spooning is a familiar action and has none of the stigma attached to suck or sip feeding.

[0189] Feeding attachment 64 is attached as shown, by a simple screw-on mechanism using corresponding sides 82 and 84 gripping corresponding parts of the end of exit channel 12, refer FIG. 9.

[0190] Feeding attachment 64 is designed for the ideal situation where: [0191] The patient sitting in the normal feeding position at the table [0192] The patient has good coordination and muscle strength [0193] The ideal intake is Level 1 thickened fluids

[0194] The design of feeding attachment 64 was made to specifically accommodate the flow-dynamics of Level 1 thickened fluids. Minor adjustments to the basic design would effectively deliver other levels of thickened fluids as well. There are 3 basic design elements that ensures the affectivity of the spoon delivery mechanism of Level 1 thickened fluids, a curved slit, the length of the neck and height of the edges and the holding cuff, as will now be described

[0195] As illustrated by FIG. 9 the exit channel of cup 1 is directed down to a 310 millimetre curved slit 80 at the bottom of the inlet, formed by wall 78. An arrow indicates the location of curved slit 80, flow being in from exit channel 12 during feeding. Flow can also slowing occur back into exit channel toward cup 1 if feeding does not take place and cup is tilted back up to be placed on a flat surface, as described further below. The particular design is necessary to prevent an overflow of spoon part 66 by the high volumeslow speed advancing liquid wave.

[0196] The length of neck and height of the neck edges, the height and shape of the spoon part edges as well as the overall shape was ergonomically designed to optimal fill with thickened fluid before spill would result at the feeding end of the spoon-part, if no drinking commences; refer FIGS. 8 and 9, in particular.

[0197] On interruption of the drinking process, such as by tilting the cup back and placing it back on the table, the volume of thickened fluid already in neck 68 and bowl 74 of feeding attachment 1 would cause spilling of the content due to the slow receding of the high viscosity fluid through the narrow entry slit, curved slit 80. The problem was solved by creating a holding cuff, refer FIGS. 8 and 9 in particular, at the base of the spoon that holds the exact volume of spoon bowl 74 when in the tilted position when tilted up, such as when the cup is set down on a flat surface. Cuff 88, indicated by an arrow on FIG. 8, widens or balloons slightly to hold the required volume while limiting edge height to prevent interference with the nose, when being used to feed. When cup 1 is placed with base 42 on a table, the high viscosity liquid is pooled in cuff 88 to allow the slow migration of the thickened fluid back into cup 1. The flow will be slow of the thickened liquid food, but gradually will flow back in the direction indicated by the arrow on FIG. 9 from cuff 88 through curved slit 80. The arrangement assist to prevent waste of the measured volume of thickened liquid food, prevents mess, as well as carefully enabling patients with early stage dysphagia to feed without the risks associated with use of a standard spoon feeding or drinking as outlined above.

[0198] Referring to FIGS. 10 to 12, a feeding attachment 90 also is designed to fit to cup 1, as described with reference to FIG. 1, prior art, and FIGS. 2 to 9 with inventive feeding attachment 64. Feeding attachment 90 also fits to exit channel 12 with a screw fit as would be readily understood.

[0199] Feeding attachment 90 has body 92 with neck 94, spout 96 and opening 98. Corresponding sides 100 and 102, refer FIG. 12 in particular, enable the screw fit to exit channel 12, as would be readily understood. Free flow of thickened liquid food from cup 1 through exit channel 12 on tipping enables food to be sucked through lip sucking by the patient.

[0200] It is important to distinguish between lip sucking and tongue sucking. Lip Sucking uses mostly the anterior (front) section of the mouth and tongue to create a negative pressure environment that draws liquid into the anterior section of the mouth. This action depend largely on Cranial Nerve No V11 (Facial Nerve) that control the facial muscles, including the lips. An example of lip sucking is drinking from a cup using a straw.

[0201] Tongue Sucking on the contrary uses primarily the whole tongue to create a negative pressure environment in the central and posterior (back) sections of the mouth that draws liquid into the posterior sector of the oral cavity. This action depend largely on Cranial Nerve No X11 (Hypoglossal Nerve) that controls most of the actions of the tongue. An example of tongue sucking is drinking from a bottle by sucking on a soft spout.

[0202] However, both methods of sucking depends heavily on the interaction of all 6 cranial nerves involved in eating, drinking and swallowing as well as voluntary nerves, reflex circuits and more than 30 muscles.

[0203] Sipper cups designed for drinking normal liquids from a small spout attached to a cup is used extensively by young children as well in Aged Care. This method of drinking utilises the lip suck method. The spouts are too small to deliver thickened fluids effectively. Taking fluids out of a Sipper Cup requires neck extension for effective delivery, with all the associated problems. Clearly it is highly undesirable for the patient to hyperextend their neck in order to feed in this manner.

[0204] Feeding attachment 90 was designed to screw onto the end of exit channel 12 of cup 1, as illustrated in FIGS. 10 to 12. This attachment is specifically designed for delivering thickened fluids to the adult mouth as per lip-suck mechanism. The sipper body is wide and curved to ergonomically fit the tongue tip and lips of the adult mouth with comfort. The wide exit of about 410 millimetres easily allows the free flow of thickened fluids. Use of the attachment allows comfortable feeding in the sitting position without neck extension. Feeding attachment 90 for cup 1 is specifically designed for the early and intermediate stages of dysphagia. It should be socially more acceptable than the tongue suck attachments, in these early stages. The design depends on effective lip suck capabilities of the patient. The basic design does not introduce any flow- or volume control measures. Feeding attachment 90 eg the basic sip attachment has to be considered a high-risk device if utilised in the later stages of dysphagia.

[0205] Referring to FIGS. 13 to 21, a valve arrangement 104 is described for use with feeding attachment 90. Clearly, where other forms of feeding attachment is used valve arrangement 104 may also be used. Again valve arrangement 104 is described with cup 1 of the prior art and used with the first and second embodiments of feeding attachment as described above. The same reference numerals are used for FIGS. 13 to 21 for cup 1, for clarity.

[0206] Valve arrangement 104 includes body 106 with tip 108 and top 110. Tip 108 is home to ball 112 and top 110 also includes valve 114. Valve arrangement 104 has been carefully designed to control the flow of thickened liquid food in a useful arrangement with cup 1 and feeding attachment 90. Valve 114 includes cross-slit 116 through which thickened liquid food can pass from exit channel 12 into feeding attachment 64 (not shown), to control the flow of thickened liquid food. Ring valve 118 is included, labelled a on FIG. 14 to prevent ball 112 accidentally leaving valve arrangement 104. Edges 120 of cusp valve 114 enable easy removal from exit channel 12 through use of the fingers.

[0207] In the middle and late stages of dysphagia (Grade 2-3) a further 2 categories of patients are addressed with this edition of device development that is, the introduction of valves. Firstly the patient who still experience significant resistance to engage with a tongue suck device due to perceived social stigmatisation. Secondly as an alternative to normal spoon-feeding to the middle and late stages of patients with pseudo bulbar palsy (Cranial Nerve IX, X & X11 deficit). The latter category is specifically expressed by difficulty in effective movement of the tongue but also include a global oro-pharyngeal paresis (poor muscle function). The predicament implicates an inability/poor ability to utilise the soft spouted tongue-suck option of feeding cup 1 and feeding attachment 90 while the patient still demonstrate some capacity to swallow. Utilising this option presumes a functional Cranial Nerve VII (Facial nerve) controlling lip and facial muscle action.

[0208] Both valves are introduced as an option to use in conjunction with feeding cup 1 and feeding attachment 90. These optional valve installations introduce an improvement in the safety profile of the feeding attachment 90. The introduction of valves control flow onlyNOT volume. No flow/very little flow will eventuate unless lip-suck is effectively executed and will seize when the negative pressure is cancelled. The only volume control would be implemented by the anatomical spatial limitations of the physiological negative space created in the anterior sector of the mouth during the lip-suck process. We suspect that this might constitute sufficient volume control for safe feeding. It might even be that further/external volume control would be confusing and might not add any real safety benefitsperhaps even have an adverse effect on feeding efficiency.

[0209] The ball-valve option also improves ease of feeding by retaining a volume of thickened fluid in the exit canal that helps to relieve muscle fatigue. Muscle fatigue is a common symptom in dysphagia involving the muscles involved in swallowing.

[0210] The basic design elements of the optional Ball-Valve installation comprises: [0211] A tube-like frame that tapers towards tip 108 with a 2 degrees inward slant on the walls which matches and fits into the tapered exit channel 12 of cup 1. [0212] Tip 108 of the valve-tube is further tapered to contain a 12 millimetre steel ball in the tube (Item b). [0213] Ring-stop 118 clicks into to base of the valve tube to further contain the steel ball 112. [0214] The Sip Attachment screws onto end of the exit channel 12 to hold the valve-tube in place. [0215] With the cup 1 standing on a level surface lip-suck is applied to the Sip mouthpiece and thickened fluid (Typically Level 1) is sucked into the valve tube from the base of the cup. The steel ball moves upward from the tip, fluid swirls around the ball and exit through the hole at the base of the valve-tube to enter the mouth via the Sip Attachment. [0216] The valve can be manually inserted and removed as a whole for cleaning and storage purposes at any time of choice.

[0217] Application: The combination of the Ball-Valve option together with the Sip Attachment give the dysphagia patient with lip-suck capabilities the opportunity to drink while sitting at the table with the cup placed upright on the surface of the table. This option of drinking against gravity assist with poor muscle power of the arms and hands, muscle fatigue, poor coordination, tremors, etc. This option also helps with poor muscle power and muscle fatigue of the facial and oral muscles, by locking the thickened liquid column in the exit channel against the effects of gravity. After a pause/rest the thickened liquid should still be present in feeding attachment 90ready to be mobilised with low effort lip-suck action.

[0218] The basic design elements of the optional Cusp-Valve installation comprises out of the following: [0219] A cup-shaped valve is constructed i.e. from silicone [0220] A cross incision in the base of the valve create 4 cusp valves. The thickness, shore value, optimal resistance to prolapse and recoil has been carefully crafted to best suit the behaviour of Level 1 thickened fluid. [0221] The valve fit firmly into the end of the cup exit and is hold in position by the Sip Attachment. [0222] The open end of the valve faces the Sip Attachment. The edge is fitted with ledge extensions to allow a fingertip to easy grip and remove the valve for cleaning or replacement purposes.

[0223] The combination of the Cusp-Valve option together with the Sip Attachment give the patient with dysphagia that still has lip-suck capabilities, the opportunity to drink out of the RoseCup (Trade Mark) cup 1 while sitting in the reclined position. The exit channel would then be horizontal or pointing downward with no need to extend the neck of the patient. The valve assists to keep flow under control when drinking in synergism with the force of gravity. Thickened fluid (Typically Type 1 Thickened Fluid) will only be released into the oral cavity when the valves and thickened fluid in the exit channel are exposed to a sufficient negative pressure gradient created in the mouth (lip sucking). When the negative pressure is cancelled during a pause/rest, the cusps will close and flow will cease. This mechanism should assist with the safe feeding of the patient with dysphagia. As explained above this mechanism controls flow only and relies on the anatomical dimensions of the anterior oral cavity dedicated to the creation of the negative space, to control volume.

[0224] The invention in various forms is highly beneficial and gives carers and health workers a great range of options. Overall the invention is a significant improvement for patients with early or intermediate stage dysphagia, in particular, and as an option for introduction to the use of the RoseCup (Trade Mark).

[0225] It will be apparent to a person skilled in the art that changes may be made to the embodiments disclosed herein without departing from the spirit and scope of the invention, in its various aspects.

REFERENCE SIGNS LIST

[0226]

TABLE-US-00001 1 Feeding Cup 10 Body of Cup 12 Exit channel 14 Mouth piece 16 Hole in mouth piece 18 Cuff 20 Lid 22 Label for lid 24 Handle 26 Handle 28 Handle 30 Join of 14 to 12 32 Bulb of 14 34 Shaped part of 14 36 Pressure hole 38 40 42 Base 44 Grip of 24 46 Grip of 26 48 Grip of 28 50 Endplate of 14 52 Cusp 54 Cusp 56 Cusp 58 Cusp 60 Anchoring point 62 Cut 64 Feeding attachment 66 Spoon part 68 Neck 70 Opening 72 Tip of 66 74 Bowl of 66 76 Floor 78 Wall 80 Curved slit 82 Corresponding sides 84 Corresponding sides 86 Screw for attachment of 12 88 Cuff 90 Feeding attachment 92 Body 94 Neck 96 Spout 98 Opening 100 Corresponding sides 102 Corresponding sides 104 Valve arrangement 106 Body 108 Tip 110 Top 112 Ball 114 Cusp valve 116 Cross-slit 118 Ring stopper 120 Edges