F.O.T.T.® Concept in detail


Premise, perspective and procedure in Facial-Oral Tract Therapy - F.O.T.T.®

  • The facial-oral functions of breathing, swallowing of saliva and food, speaking, oral cleaning movements, etc., are constantly interchanging and in a highly coordinated manner. The whole body is involved in this.
  • Central neurological disorders often affect all these areas, i.e., dysphagia rarely occurs in isolation.
  • The basis of the procedure is a knowledge of the physiological movements, facial-oral activity and motor action sequences as well as the precise analysis of the occurring pathologies. The whole-body disturbance patterns are considered in the context of the existing disease and the resulting problems in everyday life. The individual patient’s competencies, goals and context are the basis for goal-, activity- and ADL-related treatment.
  • A further basic tenet is the knowledge that learning takes place throughout life. (1), (2)



F.O.T.T.® was developed by Kay Coombes, an English speech and language therapist and Bobath tutor, in the 1970s together with her colleagues. It is based on the Bobath Concept which is a neurophysiological therapeutic approach established by Berta and Karel Bobath.

The concept is continuously developed further, integrating aspects of the Affolter-Modell and current neuroscientific models such as the principles of motor learning and neuroplasticity.

It is integrated into a multi- and interprofessional, 24-hour concept that is oriented towards and accompanies everyday life. The continuity of the therapeutic and nursing activities is made possible by the interdisciplinary cooperation of the various professional groups. Relatives are guided in this process as far as they wish and are able to do so.



The patients are helped to use the facial-oral functions as efficiently and effectively as possible in everyday life and, among other things, the development of secondary problems is prevented.

Structured therapeutic and nursing interventions start early and on a regular basis. That prevents symptoms of oral deprivation such as hypersensitivity and hyperreagibility which can result in phasic biting or even the impossibility of sufficient oral care.



F.O.T.T.® uses meaningful everyday activities in the treatment - instead of standardised exercises - which are applied individually and with variations.

Movement and action sequences are facilitated and, where it seemes necessary, work is done on the body structure level to restore movement processes and reduce limitations in the mobility of the nervous system, contractures and fascial blockages of the respective target tissue. (1)

It provides an ICF-oriented, structured and goal-directed approach to the assessment and treatment of neurogenic disorders of swallowing, oral food intake, facial expression and the area of breathing, voice and articulation in patients of all ages.