Literature on F.O.T.T.®


Facial-Oral Tract Therapy (F.O.T.T.) For Eating, Swallowing, Nonverbal Communication and Speech

The Reference book on the treatment approach for facial-oral disorders in neurological patients of all ages according to Kay Coombes.
Ricki Nusser-Müller-Busch, Karin Gampp Lehmann (Editors). Springer Nature Switzerland AG. 1st Edition 2021.
ISBN 978-3-030-51636-9 (Hardcover), 978-3-030-51639-0 (Softcover), 978-3-030-51637-6 (eBook).


Consensus recommendations for Facial-Oral Tract Therapy

The consensus recommendations outline the agreed treatment options and catalogue of measures.
Consensus recommendations (in German)


The F.O.T.T.® Algorithm

The F.O.T.T.® algorithm was developed from the consensus recommendations for F.O.T.T.® (see above).
It provides a reference framework for F.O.T.T.® with different interventions that are combined and modified. In the process of examination and treatment, the therapist is guided in his clinical reasoning and is repeatedly encouraged to reflect on his actions. Finally, the algorithm supports goal setting involving the patient and/or relatives.
F.O.T.T.® Algorithm


Supplementary literature


Eskildsen SJ, Wessel I, Poulsen I, Hansen CA, Curtis DJ (2023) Rehabilitative intervention for successful decannulation in adult patients with acquired brain injury and tracheostomy: a systematic review. Disabil Rehabil. 2023 Jul 14:1-13. doi: 10.1080/09638288.2023.2233437. Epub ahead of print. PMID: 37449332.
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Jakobsen D, Poulsen I, Riberholt C, Hvass Petersen T, Schultheiss C, Curtis DJ, Seidl RO (2019) The effect of intensified nonverbal facilitation of swallowing on dysphagia after severe acquired brain injury: a randomized control pilot study. NeuroRehabilitation 2019 18;45(4):525-536.

Mortensen J, Jensen D, Kjaersgaard A (2016) A validation study of the Facial-Oral Tract Therapy Swallowing Assessment of Saliva. Clin Rehabil. 2016 Apr;30(4):410-5.

Konradi J, Lerch A, Cataldo M, Kerz T (2015) Direct effects of Facio-Oral Tract Therapy® on swallowing frequency of non-tracheotomised patients with acute neurogenic dysphagia. SAGE Open Med 3:2050312115578958.

Kjaersgaard A, Nielsen LH, Sjölund BH (2013) Randomized trial of two swallowing assessment approaches in patients with acquired brain injury: Facial-Oral Tract Therapy versus Fibreoptic Endoscopic Evaluation of Swallowing. E-published 10 sept 2013: Journal of Clinical Rehabilitation.
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Kjaersgaard A (2013) Difficulties in swallowing and eating following acquired brain injury - from a professional and a patient perspective. The Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark and Hammel Neurorehabilitation and Research Centre.
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Hansen TS, Jakobsen D (2010) A decision-algorithm defining the rehabilitation approach: `Facial oral tract therapy'® Disability and Rehabilitation Vol 32, No 17: p1447-1460(14).
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Hansen TS (2010) Research in rehabilitation treatment for patients with severe traumatic Brain Injury: Mapping complex therapeutic procedures and developing measures of adherence and treatment outcome. Exemplified by swallowing problems and Facial Oral Tract Therapy. Copenhagen University and Department of occupational therapy/Department of neurorehabilitation. Copenhagen University Hospital, Hvidovre, Denmark.
PhD thesis

Nusser-Müller-Busch R (2008) Die Entwicklung von Konsensusempfehlungen zur Facio-Oralen Trakt Therapie (F.O.T.T.). Neuro Rehabil 14(5): 275-281.

Hansen TS, Engberg AW, Larsen K (2008) Functional Oral Intake and Time to Reach Unrestricted Dieting for Patients with Traumatic Brain Injury. Arch Phys Med Rehabil Vol 89 Issue 8, Pages 1556-1562.

Hansen TS, Engberg AW, Larsen K (2008) The Association of Functional Oral Intake and Pneumonia in Patients with Severe Traumatic Brain Injury. Arch Phys Med Rehabil Vol 89 Issue 11 Pages 2114-2120.

Frank U, Sticher H, Mäder M (2008) Trachealkanülenmanagement in der Dysphagietherapie: Evaluation eines multidisziplinären Interventionsansatzes. Neuro Rehabil 2008; 14 (2): 79-88.

Seidl RO, Nusser-Müller-Busch R, Westhofen M, Ernst A (2007) Pilot Study of a neuro-physiological dysphagia therapy for neurological patients. Clinical Rehabilitation Vol 21 686-697.

Frank U, Mäder M, Sticher H (2006) Dysphagic Patients with Tracheotomies: A Multidisciplinary Approach to Treatment and Decannulation Management. J Dysphagia 2006:1-10.


Nusser-Müller-Busch R, Gampp Lehmann K (2021) Facial-Oral Tract Therapy (F.O.T.T.). For Eating, Nonverbal communication and Speech. Springer nature Switzerland.

Gampp Lehmann K, Marschner-Preuth N (2020) Sprach-, Sprech- und Schluckstörungen. Kapitel 32. In: Knuchel-Schnyder, S. (Hrsg), Leitfaden Geriatrie Physiotherapie. 1. Auflage. Elsevier, München.

Kjærsgaard A (2020) Ansigt, mund og svælg. Ergo/Fys Munksgaard.

Nusser-Müller-Busch R (Hrsg. 2015) Die Therapie des Facio-Oralen Trakts. 4. Auflage Springer Berlin.

Nusser-Müller-Busch R (2013) F.O.T.T. - Therapie des Facio-Oralen Trakts. In: Fiedler, Köhrmann, Kollmar (Hrsg.) Pflegewissen stroke unit. Springer Berlin 189-199.

Nusser-Müller-Busch R (2011) Logopädie: Atmung und Schlucken sichern und koordinieren - die Therapie des Facio-Oralen Trakts nach Coombes (F.O.T.T.). In: Nydahl P (Hrsg.): Wachkoma. Betreuung, Pflege und Förderung eines Menschen im Wachkoma. Elsevier, München, 3. Auflage.

Gampp Lehmann K (2011) Anatomical interrelations between posture and swallowing: why does malposition interfere with swallowing? In: Marzalek S, Majchrzycki M, Golusinski W: 'Dysfunctions of the Locomotor System'. Physiotherapy in Head and Neck Cancer. Poznan University of Medical Sciences.

Elferich B (2011) F.O.T.T.-Therapie des Facio-Oralen Trakts. In: Frey S (Hrsg.): Pädiatrisches Dysphagiemanagement, Elvesier München.

Müller D (2011) Ergotherapie. In: Oehmichen F, Pohl M & Koschel D: Außerklinische Intensivpflege. Ein Leitfaden. Zuckwerdt, München.

Gratz C (2009) F.O.T.T.: Die Therapie des Facio-Oralen Trakts. In: Kolster F, Habermann C (Hrsg.): Ergotherapie in der Neurologie, Lehrbuch-Reihe Thieme Stuttgart.

Gratz C, Müller D (2004) Die Therapie des Facio-Oralen Traktes bei neurologischen Patienten - Zwei Fallbeispiele. Schultz-Kirchner, Idstein 3. Auflage.

Coombes K (1996) Von der Ernährungssonde zum Essen am Tisch. In: Lipp B, Schlaegel W (Hrsg.) Wege von Anfang an. Frührehabilitation schwerst hirngeschädigter Patienten. Neckar, Villingen-Schwenningen, S 137–143.

Coombes K (1991) Voice in people with cerebral palsy. In: Fawcus M (Editor) Voice disorders and their management. Chapman & Hall, London.


Nusser-Müller-Busch R, Jädicke M (2022) Vom Entblocken zur Teilhabe - Trachealkanülen-Management beginnt auf der Intensivstation. forum:logopädie Jg. 36(4) Juli 2022 16-21.

Sticher H, Gampp Lehmann K (2017) Das Schlucken fördern. ergopraxis 7-8/17: 28-31. Thieme Stuttgart.

Sticher H, Gampp Lehmann K (2017) Das Schlucken fördern. physiopraxis 3/17: 38-41. Thieme Stuttgart.

Kjaersgaard A (2013) Synke og spiseproblemer efter erhvervet hjerneskade. Ergoterapeuten 12:13: 34-37 (in Danish).

Nusser-Müller-Busch R (2013) Schluckstörungen auf der Intensivstation: Atmen und Schlucken - eine vitaAnsile Beziehung, Deutscher Ärzte-Verlag DIVI 13;4:7-14. DOI 10.3238/DIVI.2013.0007-0014.

Nusser-Müller-Busch R (2012) Mundpflege bei hirngeschädigten Patienten. Interdisziplinäre Rehabilitation. In: Krüger L, (Hrsg.) Keine Frage des Alters. Richtige Zahn- und Mundpflege (Lerneinheit). CNE.fortbildung 2012; Heft 5.

Penner H, Bur T, Nusser-Müller-Busch R, Oster P (2010) Logopädisches Vorgehen bei Dysphagien im Rahmen der Palliativmedizin. Z Palliativmed 2010;11(2): 61-75 DOI: 10.1055/s-0029-122348.

Kjærsgaard A (2002) Undersøgelse af synkeproblemer hos senhjerneskadede patienter (assessment of swallowing difficulties in patients with acquired brain injury). 2002. Hammel Neurocenter (in Danish).
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Coombes K (2001) Facial Oral Tract Therapy (F.O.T.T.). In: Therapiezentrum Burgau (Hrsg.) Jubiläumsschrift 10 Jahre Schulungszentrum am Therapiezentrum Burgau. Kapuzinerstraße 34 89331 Burgau.

Gampp K (1994) Die Behandlung des orofacialen Traktes bei Patientinnen nach Schädel-Hirn-Trauma auf der Intensivstation. FORUM Logopädie 4: 13–16.

Gampp K, Gattlen B (1991) Physiotherapie in der Frühphase nach Schädel-Hirn-Trauma. Schweiz Physiotherapie Zeitschrift 6: 12–18.

Coombes K (1987) Swallowing function in hemiplegia and head injury. Course presented by International Clinical Presenters, Aug 24-27th, 1986 and Aug 24-28th, 1987, Los Gatos, California.

Coombes K, Davis J (1987) Model: The process of evaluation and treatment. Published International Clinical Educators, USA.


Jakobsen D, Seidl R, Poulsen I, Curtis DJ (2021) Treatment of Dysphagia with Biofeedback and Functional Electrical Stimulation in a Patient with Wallenberg Syndrome: A Prospective Case Report. Case Rep Neurol 2021:789-796. doi: 10.1159/000518910.
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Eskildsen SJ, Poulsen I, Jakobsen D, Riberholt CG, Curtis DJ (2021) Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury. BMJ Open. 2021 Dec 2;11(12):e053244. doi: 10.1136/bmjopen-2021-053244. PMID: 34857571; PMCID: PMC8640633.

Gampp Lehmann K, Wiest R, Seifert E (2020) Physiotherapy-related late onset clinical and grey matter plasticity changes in a patient with dysphagia due to long-standing pseudobulbar palsy - a longitudinal case study. Synapse-ACPIN: March 2020: 4-11.

Schultheiss C, Wolter S, Schauer T, Nahrstaedt H, Seidl RO (2015) Einfluss der Körperposition auf die Atem-Schluck-Koordination HNO. 2015 Jun;63(6):439-46. German. doi: 10.1007/s00106-015-0016-7. PMID: 26059790.

Seidl RO, Nusser-Müller-Busch R, Ernst A (2002) Evaluation eines Untersuchungsbogens zur endoskopischen Schluckuntersuchung. Sprache Stimme Gehör, 2002: 26: 28-36, Thieme, Stuttgart.

Seidl RO, Nusser-Müller-Busch R, Ernst A (2002) Der Einfluss von Trachealkanülen auf die Schluckfrequenz bei neurogenen Schluckstörungen. Neuro Rehabil 2002; 8:122-125.


Nusser-Müller-Busch R et al. (2012) ATL Essen und Trinken. In Thiemes Pflege, Thieme Stuttgart 12. Auflage.

Seidl RO, Nusser-Müller-Busch R (2011) Endoskopische Schluckuntersuchung (FEES) bei Kindern. In: Frey S (Hrsg.): Pädiatrisches Dysphagiemanagement, Elvesier München.

Nusser-Müller-Busch R (2009) Schluckstörungen. In: Kolster F, Habermann C (Hrsg.): Ergotherapie in der Neurologie, Lehrbuch-Reihe Thieme Stuttgart.



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