Dysphagic patients with tracheotomies: a multidisciplinary approach to treatment and decannulation management

In 2000 a multidisciplinary protocol for weaning dysphagic patients from the tracheotomy tube and a decannulation decision chart created according to principles of the F.O.T.T.((R)) Concept (Face and Oral Tract Therapy) were introduced in the Swiss Neurological Rehabilitation Centre REHAB in Basel. In the present study we introduce these guidelines and present an evaluation of the treatment and decannulation procedure. We retrospectively compared data from patients before and after introduction of the multidisciplinary procedure with regard to mean cannulation times and success of decannulation. Furthermore, we analyzed the rehabilitation progress of the group who underwent multidisciplinary treatment as well as the participation of the speech language therapist. The results show that the treatment introduced to improve swallowing functions and wean patients from the tracheotomy tube led to a fast and safe decannulation of our patients. The mean length of cannulation time was reduced significantly. After decannulation the patients showed clear functional improvements. Interdisciplinary treatment using the approach discussed in this study can be considered efficient and an important basis for further functional progress in the rehabilitation process.