Severe feeding difficulties exhibited by persons with acquired brain damage are a major concern for occupational therapists working in postacute rehabilitation settings. Clients with feeding difficulties may exhibit increased risks of life-threatening situations, such as aspiration, and demand an enormous amount of supervision. In the present paper, two cases are presented to illustrate the use of a combination of an applied behaviour analysis approach with utensil adaptation or cognitive retraining to enhance independent self feeding. In the first case, the applied behaviour analysis approach of shaping procedure followed by the provision of adaptive utensils is used to improve self-feeding compliance of a man with severe ataxia. In the second case, the applied behaviour analysis approach of paced-prompting and the cognitive retraining approach of the re-auditorization technique are used to improve the mealtime behaviour of a woman whose lack of self-monitoring skills were severely affecting her safety in self feeding.