Ricki Nusser-Müller-Busch (editor) - Facial-Oral Tract Therapy (F.O.T.T.): For Eating, Swallowing, Nonverbal Communication and Speech

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Karin Gampp Lehmann (PT), Ricki Nusser-Mller-Busch (SLT), Daniela Jakobsen (OT), Heike Sticher (PT), Claudia Gratz (OT), Doris Mller (OT), Margaret Walker (OT), Barbara Elferich (OT). In the background: Rainer Seidl (ENT). Not in photo: Jrgen Meyer-Knigsbscher (SLT)

Facial-Oral Tract Therapy (F.O.T.T.) has been used in Europe for the past 40 years. With improved long-term survival after severe brain injury, pioneers including speech therapist Kay Coombes and colleagues were challenged to provide new strategies for treating these patients. Based on the Bobath concept, Coombes developed F.O.T.T. to assess and treat impairments of the face and oral tract. The approach encompasses four main areas: eating, drinking and swallowing; oral hygiene; nonverbal communication; and breathing, phonation and speech.

F.O.T.T. is based on profound knowledge and understanding of the influence of posture and movement on facial-oral functions. This enables members of the rehabilitation team to detect, analyze and interpret changes in motor activity, including pathological behaviour. Depending on their capabilities, patients are guided to relearn and maintain a wide selection of different functions and to be as independent as possible. Therapy is designed to help patients experience posture and movement that is as normal as possible. Treatment makes use of activities of daily living to elicit and facilitate meaningful movements rather than abstract exercises. Therapists and nurses apply current knowledge of neurosciences and involve carers and relatives in the treatment process.

Dysphagia after brain lesions should not be treated in isolation from other impairments of the facial-oral tract! The patients need to learn more than just how to swallow again. They need to relearn to use their tongue to clean their teeth and oral cavity, to eat independently, to clear their throat, to spit out and swallow afterwards!

Many neurological conditions persist throughout life and require specialised long-term treatment. Breathing, airway protection, nutrition and oral hygiene are often critical issues in the care for severely impaired patients. The goal is to promote participation and to improve quality of life.

For years, we have been asked at international congresses and conferences to provide an English version of the established German-language book on F.O.T.T. The book covers a range of interconnected areas, including food intake, oral hygiene, facial expression, breathing and phonation. Special chapters are dedicated to sensorimotor learning, the treatment of children, tracheostomy tube management and the evaluation of the approach. This is a practice-oriented book rather than an exhaustive account. It is aimed at those working in the field of neurology including relatives and carers.

Facial-Oral Tract Therapy - F.O.T.T. was protected by the founder of the approach Kay Coombes. In order not to interfere with the flow of reading, we have chosen the spelling without the trademark .

Daniel is a 22 year old patient in the Intermediate Care Unit following traumatic brain injury. Although his reactions are still very slow, he seems to understand and tries to speak but is not yet able to coordinate voice and speech movements. His swallowing frequency is also reduced. Oral nutrition is still out of question. His girlfriend is present during therapy.

To understand the following situation, it should be noted that Daniel calls his girlfriend by the nickname Earth.

Today Daniel is feeling tired. For the first time he stood upright during physiotherapy. Now he is well positioned in a wheelchair with his eyes closed. His girlfriend understandably has different expectations. Earth calling Daniel... dont go to sleep, Im here now...

Treatment adheres to the principles of Facial-Oral Tract Therapy (F.O.T.T.):

Involvement of relatives in the therapy

The therapist, who by age could be Daniels mother, assumes that the patients girlfriend might contribute more effectively toincrease his level of alertness.

Setting the scene

The therapist supports Daniels background posture and guides his arm and hand to touch Earths face, neck, arms and hands. A deep sigh is heardFurther input is required!

The therapist designs a starting position for the girlfriend to get her involved in the treatment: Earth sits alongside Daniel and very close to him.

Facilitating the sensorimotor loop, taking environmental factors into account: context-related input processing - output

After a time, she asks Earth to give Daniel a kiss and then after a slightlyprolonged processing timeDaniels