Thermal-Tactile Stimulation (TTS)



Purposes of Exercise:
– Reduce swallow deconditioning when unsafe for oral feeding
– Assist secretion management when not feeding orally
– Reduce microaspiration risk

Tips / Precautions:
– Some therapists may suggest alternative products which are acceptable, such as a laryngeal mirror or lemon glycerin swab stick
– If the client gags, repeat the exercise with the spoon slightly more to the front of the mouth, or perform the exercise more quickly, and remove the spoon from the mouth faster
– If the client has poor oral hygiene (e.g. significant amounts of sticky or dried saliva/sputum), make sure to wipe the spoon clean of any visible gunk after each repetition
– If the client cannot tolerate this exercise, you may wish to perform Cold Spoon Press (Tongue) instead. This may also be effective at triggering a swallow in patients unsafe for oral feeding, while being better tolerated
– Remove any upper dentures before performing this exercise

Research Articles:*
– Hwang, C. H., Choi, K. H., Ko, Y. S., & Leem, C. M. (2007). Pre-emptive swallowing stimulation in long-term intubated patients. Clinical Rehabilitation, 21(1), 41-46.
– Power, M. L., Fraser, C. H., Hobson, A., Singh, S., Tyrrell, P., Nicholson, D. A., Turnbull, I., Thompson, D. G., & Hamdy, S. (2006). Evaluating oral stimulation as a treatment for dysphagia after stroke. Dysphagia, 21(1), 49-55.
– Regan, J., Walshe, M., & Tobin, W. O. (2010). Immediate Effects of Thermal–Tactile Stimulation on Timing of Swallow in Idiopathic Parkinson’s Disease. Dysphagia, 25(3), 207-215.
– Rosenbek, J. C., Robbins, J., Fishback, B., & Levine, R. L. (1991). Effects of thermal application on dysphagia after stroke. Journal of Speech and Hearing Research, 34, 1257–1268.
– Rosenbek, J. C., Roecker, E. B., Wood, J. L., & Robbins, J. (1996). Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia, 11(4), 225-233.
– Teismann, I. K., Steinsträter, O., Warnecke, T., Suntrup, S., Ringelstein, E. B., Pantev, C., & Dziewas, R. (2009). Tactile thermal oral stimulation increases the cortical representation of swallowing. BMC Neuroscience, 10(1), 71.

*Articles cited are a limited sample only, and there may be other & more recent evidence which supports / contraindicates use of this exercise.


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