Facial Oral Tract Therapy: 
F.O.T.T™

  • F.O.T.T. provides a structured way to assess and treat disturbances in one or more of the following: facial expression, movement of the jaw and tongue for eating and articulation, breathing, swallowing, voice.  Symptoms occur in a range of conditions and vary in severity. Causes may be easy to identify but sometimes diagnosis is difficult.
  • F.O.T.T is used by therapists, nurses and relatives working with children or adults who have movement problems, impaired sensation and perception.
  • Main topic areas are: nutrition, oral hygiene, non-verbal communication, breathing and voice.  F.O.T.T. is an holistic approach and takes account of these areas in the context of the whole body.
  • F.O.T.T. principles are based on:
  • a thorough understanding of normal human movement, sensation and learning
  • the ways in which these can be disturbed or distorted
  • careful analysis of difficulties
  • skillfull handling to influence posture,  movement and sensation
  • the application of these principles to the particular individual without requiring them to understand speech
  • Therapy  fosters learning through how it feels to carry out everyday activities, such as cleaning the teeth, eating and drinking (or being fed), rather than by “exercises”.  Progress is monitored and evaluated.
  • The goal is to prevent the accumulation of symptoms, reduce disability, avoid handicap, build confidence and enable individuals to become as comfortable and independent as possible.
  • Therapy promotes helpful experience throughout the 24 hours by enabling the person to receive therapeutic feedback from their own body and their environment (bed, chair, etc). 
  • Careful attention is paid to the entire sequence of an activity from initiation, including getting ready to do something, to completion of the task. Example: the initiation of eating normally involves a preparatory stage of anticipating our meal. We get into a 'state of readiness' and this pre-oral phase is an automatic preparation for food or drink being taken into the mouth.

The normal pre-oral phase is essentially a state of sensori-motor “readiness”. It involves anticipatory saliva production and possibly swallowing, in response to smelling food, or seeing it.  An automatic and appropriate “postural background” provides optimal alignment of head, shoulders and trunk.  This gives a stable foundation for manual dexterity and eye-hand co-ordination to hold the food or cutlery, the movement of the arm  to the take food to our own mouth, head control and co-ordinated jaw opening.  These important operations “set the scene” for the oral phase.  The oral phase in turn influences timing and co-ordination of the pharyngeal phase.

Alignment of the body and dynamic stability are often dramatically changed in neurological conditions such as cerebral palsy, stroke, M.S. or head injury. For example, the trunk may be rounded, the head translocated forward in a compensatory pattern of extension and this is likely to lead to a similar pattern of extension in the face.  So, if the neck is hyper-extended, the forehead is often raised as part of the extension pattern and the jaw is depressed and retracted; the mouth is typically open, with retracted lips exposing the gums and teeth.  Impairment of tongue movement is exacerbated by this pattern which inhibits selective tongue movement, because of the way in which it encourages retraction of the tongue (as part of the extension pattern).

Without careful handling to facilitate more normal tension (tonus) in the muscles and appropriate response to sensory input, such an individual is likely to demonstrate intolerance of touch (tactile input).  This is manifested by hypersensitive and stereotyped responses such as a bite reflex which makes oral hygiene difficult and functional movement impossible.                      

The face, mouth and hands are rich in sensation and afford enormous possibilities for sensori-motor learning, given appropriate input and an adequate background posture. This is supported in literature about rehabilitation (Davies in “Steps to Follow” 1989 and “Starting Again” 1994 Springer Verlag).            

Kay Coombes
  • Therapeutic sensory feedback from the patient’s own body is the route to recovering his or her own life and becoming as independent as possible. Therapy bas
    ed on F.O.T.T. principles is effective in treating subtle difficulties as well as the dramatic symptoms found in many individuals with severe brain injury.
  • Advances in acute medicine and technology have increased survival and life expectancy for children and adults with severe neurological conditions, including catastrophic acquired traumatic brain injury.  However, people are liable to survive with significant disturbances of movement and sensation.  This means that it is important to start F.O.T.T. as early as possible.  In unconscious individuals, the goal is to prevent “sensory deprivation” which contributes to hypersensitive (“defensive”) responses, such as withdrawal and bite-reflex and leads to other secondary symptoms.  Treatment methods include slow, organised touch of the individual's hands and bringing them to their own face or body together with specific oral stimulation, therapeutic oral hygiene routines and facilitation of swallowing.
  • F.O.T.T. is based on the Bobath Approach.  Since 1975 the application of F.O.T.T to therapy for patients with acqu
  • ired brain injury has been developed by Kay Coombes, Founder member and Director of ARCOS.
  • F.O.T.T. courses are held throughout the UK, continental Europe and  Scandinavia. 

ARCOS Website