Facial Oral Tract Therapy (F.O.T.T)

Facial Oral Tract Therapy is a comprehensive approach to the assessment and treatment of disturbances in facial expression, oral movement, swallowing, breathing, voice and speech production caused by neurological conditions such as stroke, brain injury, multiple sclerosis and motor neurone disease.

Four main areas are concerned: nutrition, oral hygiene, non-verbal communication and speech movements.

F.O.T.T is a practical, hands on, approach founded on the work of Berta and Karel Bobath. It is based on an understanding of human function and experiential learning.

There may be pathological patterns of biting, chewing and swallowing in adults with acquired neurological disorders making it difficult for individuals to self-feed and making them reliant on others to feed them. F.O.T.T. is a 24-hour therapeutic approach using real life activities.

F.O.T.T Goals

  • To facilitate long term function
  • To prevent deformity and pain due to deterioration over time

F.O.T.T Principles

Eating and drinking problems respond to treatment of the whole individual. Swallowing is influenced by a number of factors that are taken into account during treatment:

  • Muscle tone and body posture
  • Balance and dynamic stability
  • The position of carer and the way in which food is presented
  • Food texture
  • Mealtime environment e.g. noises and visual distractions
  • F.O.T.T emphasises the role of sensation-feeling or feedback from the body’s position and movement, this is more effective than telling someone how to move or eat or relying on vision
  • Learning in F.O.T.T does not require an understanding of spoken language and the individual is not guided by verbal direction but by physical touch and handling
  • F.O.T.T seeks to prevent unhelpful learning experiences e.g. swallowing with the head falling or tilted backwards which is unsafe as this opens the airway.
  • F.O.T.T handling facilitates more normal muscle tone and gradually increases tolerance to touch to help those with hypersensitivity making feeding and teeth cleaning easier.
  • F.O.T.T avoids “forced experience” in providing nutrition and maintain oral hygiene. Force-feeding and physical restraint during teeth cleaning are counterproductive
  • In F.O.T.T attention is paid to the entire sequence of an activity for example with eating and drinking emphasis is on the pre-oral stage which is to promote the readiness for eating for those with eating difficulties. Preparing seeing it, smelling it, cutlery and handling of food.

F.O.T.T therapy sessions will seek to identify facilitative swallowing postures/techniques and therapeutic oral hygiene, reduce hypersensitivity, emphasise the pre-oral stage to aid readiness for the receipt of food/fluids. Assessment will be carried out followed by a specifically tailored treatment plan which will include training to carers on how to implement the F.O.T.T techniques into everyday activities as appropriate.

F.O.T.T will be offered in blocks of therapy with review sessions as appropriate. It will be charged at £75 per hour and the number of sessions needed will be determined following assessment. Please contact me for more details if interested in this approach. If you come to me and I deem it to be an appropriate approach I will suggest it and give you more details at the time.