Therapy of the facio-oral tract

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The treatment of Facio-Oral tract (also Facio-oral tract therapy , FOTT ) is an interdisciplinary approach to rehabilitation for the treatment of patients with brain damage. The exercises are intended to improve swallowing, breathing and speech disorders. The concept was developed and trademarked by British speech therapist Kay Coombes in the 1980s. The practitioners are trained and certified in private institutes. To date, there has been no randomized controlled trial for evidence-based proof of effectiveness . Accordingly, it is not to be found in the guideline “Neurogenic Dysphagia” of the AWMF , although it was mentioned once in the outdated guideline from 2008 in non-cooperative or consciously disturbed patients.

scope of application

The FOTT is used in patients with congenital and acquired brain damage, swallowing disorders and facio-oral problems in all rehabilitative phases of the disease (A – F), right through to soothing measures in the palliative phase. It is also possible with impaired patients, e.g. B. with severe traumatic brain injuries, after strokes as well as in a vegetative state, and is mainly performed by speech therapists , occupational therapists and physiotherapists .

Treated are: newborns, infants and children with cerebral paresis and the resulting multiple disabilities and syndromes ; Patients after a stroke , traumatic brain injury , with Parkinson's disease , amyotrophic lateral sclerosis , multiple sclerosis etc. as well as patients with non-neurological problems with speech and swallowing disorders, e.g. B. with or after long-term / continuous ventilation with or without tracheostomy tubes .

concept

The functions and activities of the facial-oral tract include swallowing , coughing , clearing throat , sneezing , and yawning ; Bringing food to the mouth, chewing, drinking and swallowing different consistencies; Communication and facial expression; Oral hygiene: being able to remove leftover food from the oral cavity with the tongue, brushing teeth, rinsing, spitting out, swallowing; Breathing / vocalization / speaking.

According to the FOTT, posture control has an impact on the functions of the face, mouth and throat. Brain damage can manifest itself to varying degrees in disorders of posture control and balance, mobility, muscle tension, but also perception, sensitivity, higher brain functions and cognition. Patients can often no longer cope with their everyday lives. Daily activities such as walking upright, dressing, grooming, and performing oral hygiene are affected as well as swallowing saliva or food, breathing, speaking, and coughing efficiently. The automated switching between individual activities can also be impaired.

The FOTT has its roots in the Bobath concept . Similar to this, there are no prescribed exercises that are the same for all patients. Rather, the procedure should be adapted to the individual potential. It is used: activation (facilitating, supporting etc.) of movements and functions, increasing the degree of severity (shaping) and repetitions. The necessary movement sequences are developed during the treatment. Hands on techniques, e.g. B. FOTT mouth stimulation, therapeutic oral hygiene, therapeutic eating and tracheostomy tube management are used. The use of hands-on techniques makes it possible to work with impaired patients, as they do not have to implement verbal requests.

history

The British speech therapist Kay Coombes developed this rehabilitation approach in the 1980s in collaboration with the founders of the Bobath concept Karel and Berta Bobath and the speech therapist Helen Mueller.

With the advent of neurorehabilitation in Swiss rehabilitation clinics, Kay Coombes further developed this approach. Max Schuster , the affected father and initiator of the therapy center for craniocerebral injuries in Burgau , founded in 1989 , brought Kay Coombes, Félicie Affolter as well as Karel and Berta Bobath and Pat Davies to southern Germany. At the same time, on the initiative of the geriatrician Hans-Peter Meier-Baumgartner, a collaboration with the Albertinen-Haus in Hamburg began.

In 1994 Coombes founded a specialist society for all professions in rehabilitation (physical, occupational and speech therapy, nursing and medicine). She is also director of the UK Foundation for the Association for the Rehabilitation of Communication and Oral Skills (ARCOS).

literature

  • K. Coombes: From the feeding tube to eating at the table. In: B. Lipp, W. Schlaegel (eds.): Paths from the beginning. Early rehabilitation of severely brain-damaged patients. Neckar, Villingen-Schwenningen 1996, ISBN 3-7883-0283-6 .
  • C. Gratz, D. Müller: The therapy of the facio-oral tract in neurological patients. 3. Edition. Schulz-Kirchner Verlag, Idstein 2004, ISBN 3-8248-0175-2 .
  • R. Nusser-Müller-Busch (Hrsg.): The therapy of the Facio-Oralen Trakt. 4th edition. Springer, Berlin 2015, ISBN 978-3-662-47633-8 .

Sources and individual references

  1. ↑ dgn.org
  2. ↑ dgn.org (accessed March 26, 2015)
  3. ↑ C. Gratz, D. Müller: The therapy of the facio-oral tract in neurological patients. 3. Edition. Schulz-Kirchner Verlag, Idstein 2004.
  4. ^ PM Davies: Hemiplegia. 2nd Edition. Springer, Berlin 2002.
  5. ↑ D. Jakobsen, T. Schow: FOTT algorithm: move in and with the concept. In: R. Nusser-Müller-Busch (Hrsg.): The therapy of the Facio-Oralen Trakt. 4th edition. Springer Verlag 2015.
  6. ↑ D. Jakobsen, B. Elferich: Oral hygiene: input for swallowing, cleaning and protection in everyday life. In: R. Nusser-Müller-Busch (Hrsg.): The therapy of the Facio-Oralen Trakt. 4th edition. Springer, Berlin 2015.
  7. ↑ D. Müller, J. Meyer-Königsbüscher: Food intake - more than swallowing. In: R. Nusser-Müller-Busch (Hrsg.): The therapy of the Facio-Oralen Trakt. 4th edition. Springer, Berlin 2015.
  8. ↑ H. Sticher, C. Gratz: Tracheal cannula management in the FOTT: the way back to physiology. In: R. Nusser-Müller-Busch (Hrsg.): The therapy of the Facio-Oralen Trakt. 4th edition. Springer, Berlin 2015.
  9. ↑ RO Seidl, R. Nusser-Müller-Busch, A. Ernst: The influence of tracheal cannulas on the swallowing frequency. In: Neurol Rehabil. 8, 2002, pp. 302-305.
  10. ↑ fott.eu
  11. ↑ arcos.org.uk