24 Benefit of therapeutic oral trials in dysphagia rehabilitation

Abstract

Abstract Background Therapeutic oral trials (also known as ‘swallow trials’) are one therapeutic approach offered by Speech and Language Therapists (SLTs) as part of dysphagia rehabilitation. It involves offering prescribed amounts of a specified consistency of food and/or fluids to patients whom it is felt would not safely take full portions of oral intake due to risk of aspiration. These patients typically receive the majority of their nutrition and hydration artificially with the purpose of therapeutic oral trials being comfort, enjoyment and an opportunity to swallow in a functional manner (incorporating principles of neuroplasticity such as specificity, intensity and grading). Methods Three patients >60 years age from a variety of patient cohorts (stroke, cardiothoracic surgery, critical care) presented with moderate–severe dysphagia (confirmed on instrumental assessment). All received full nutrition and hydration via nasogastric tube. All received baseline clinical bedside assessment and Fibreoptic Endoscopic Evaluation of Swallowing (FEES). Based on the results of same, programme of dysphagia rehabilitation exercises were provided. All patients also received daily swallow rehab consisting of therapeutic oral trials (ice chips, fluids, diet) along with traditional exercises. Repeat FEES was completed after three weeks to assess progress and guide recommendations for oral intake and rehab. Results After three weeks, all patients showed two point improvements on dysphagia outcome severity scale. After six weeks, all patients were on full oral intake, no longer receiving artificial nutrition. Anecdotally, all patients reported that therapeutic oral trials provided significant enjoyment and added to quality of life. SLTs subjectively noted improved engagement and improved oral hygiene versus swallow rehab alone. Conclusion The concept of therapeutic oral trials builds on principles of neuroplasticity and are a useful adjunct in the dysphagia rehab toolbox of the SLT. They can have clinical benefit and support traditional rehabilitation. Importantly, patients report significant enjoyment and improved swallow-related quality of life when receiving them.