IQoro is listed as a treatment for dysphagia by the NHS. This page will give you more information on how you can use IQoro to treat your patients, expected results and how IQoro works.
Can IQoro help my patient?
IQoro can successfully help almost anybody suffering from dysphagia, and is suitable for both adults and children.
Clinicians often use IQoro to treat dysphagia in the following groups:
- Stroke patients
- Patients with acquired brain injuries
- Patients with traumatic brain injuries
- Patients with neurological diseases
Treating paediatric patients with IQoro is usually done as part of a rehabilitation programme or in facilitating the neuro development of the swallow.
IQoro is available in two sizes: child and adult. The child size can be used from when the stomach has descended below the diaphragm (often at around 12 months), up to about 8-10 years.
How does IQoro treat dysphagia?
IQoro is a neuromuscular treatment. It stimulates normal sensory and motor nerve activity to strengthen and coordinate weakened musculature and by that, it also treats dysphagia.
Strengthened muscles and nerve pathways
There can be many causes behind dysphagia. These include stroke, acquired or traumatic brain injury, neurological diseases and radiation treatment. What they all have in common is damaged nerve functions.
IQoro addresses and strengthens the function of all the musculature involved in a healthy swallow, and the nerve pathways that control it.
IQoro trains the whole swallow chain, promotes neuroplasticity enabling the re-learning of coordinated patterns of a normal swallow, and exercises and strengthens the musculature of the oesophagus, the diaphragm, and beyond.
It does this by provoking and exaggerating the movements of the normal swallow including holding the base of the tongue in contact with the posterior pharyngeal wall for up to 10 seconds.
The training action provokes intense stimulation to the brain stem causing a sensory motoric reflex arc that stimulates all the muscles of the swallowing chain including those only under the involuntary control of the autonomic system.
This holistic treatment means that IQoro is suitable for treating all four phases of dysphagia: pre-oral (facial activity is improved aiding the placement of food in the mouth), oral, pharyngeal, and oesophageal dysphagia.
Grade a patient’s treatment
Optimal IQoro training is recommended as 3 sessions per day. Each session consists of 3 x 10 seconds pull, with a few seconds rest between each pull. This is usually manageable for all patients after a period of introduction.
However, therapists may find themselves working with some of the most poorly patients who may have comorbidities, or in situations where the reaction to an intervention appears unclear. In these cases understanding how to grade the use of IQoro is important, using clinical judgement to select and adapt an intervention to a specific patient’s need.
Where a therapist feels that grading of treatment is required the therapist is advised to consider:
Reducing the strength of the pull
Start gently with a light pull and increase successively as the patient is increasingly able. Even a light level of training provides the patient with neuromuscular stimulation and for some patients, this can be the important entry point to their rehabilitation process.
Reducing the length of time of each pull
Deciding how much to reduce the length of pull and when to increase, will be part of a therapist’s clinical assessment and judgement. Where therapists want to use IQoro with extreme care they may wish to start with 3 times 2-3 seconds pulls only, moving on to 3 x 5 seconds, then 7 seconds and finally 10 seconds, over a period of time.
Reducing the number of daily sessions
In some cases, starting with training sessions just twice a day rather than three may also be a choice for the therapist.
What results might be expected?
Recovered orofacial ability
Patients recover facial sensation and improve orofacial motor control. In turn, this leads to these further functional improvements.
Saliva control improves due to better ability to swallow, especially reflexively, a decrease in the additional secretions caused by acid reflux, and the reduction of open mouth syndrome. Success here can lead to avoiding surgical interventions and ceasing sialorrhea medication.
Normalized eating and drinking
Patients who are using drink thickeners, modified solid foodstuffs or enteral feeding can usually be expected to show improvement towards more normal eating behaviours.
Chewing and swallowing abilities improve, allowing the SLT to guide the patients through the IDDSI levels towards normal drink and food consistencies. In many cases PEG feeds can be avoided or reversed even years after insertion.
In cases of long-term progressive conditions some patients can temporarily improve their chewing and swallowing functions and retain their ability for a longer time than would have been possible without IQoro treatment. There are no specific scientific studies of patients in this category.
Improved orofacial function and breath control can lead to better speech articulation and volume. Voice quality will improve where a gurgly or hoarse voice is caused by acid reflux and this is successfully addressed by IQoro training.
Reduction in repeated chest infections
Where patients suffer repeated bouts of pneumonia due to aspiration, training with IQoro will instead promote a healthy swallow and tend to avoid aspiration-caused infections.
The musculature and mechanisms that control posture can be damaged after a neurological injury. These systems are controlled from the same part of the brain cortex as the swallowing chain and respond to IQoro treatment.
IQoro training is being explored as an aid in tracheostomy weaning, even in cases where the trachy has been in place for several years.
When might I expect to see the first results?
Patients and therapists will be eager to know what treatment periods can be expected. The scientific studies were mostly based on a 13-week treatment period, although the SOFIA study was only 5 weeks. In some cases – especially where a Hiatal hernia was the underlying problem – the treatment period was 6 months.
At the end of the treatment assessment, some patients were not fully recovered but most were. Of those that had successful outcomes, the results were achieved at some stage during the study, not necessarily at the end-of-treatment.
In clinical experience patient results seem to start to be visible at all time points: in rare cases within a week, often within a month and sometimes only after a much longer period. In clinical practice, IQoro treatment should be continued until further improvements are no longer being seen.
In some cases, even after this, a lower level of background training will be necessary – especially when treating Hiatal hernias. Where the patient’s condition was caused by a neurological incident it is usually the case that maintenance training is not required after normal competence has been restored.
Measurement is a key part of condition management. By assessing patient ability thoroughly at baseline it is possible to track improvements. Several appropriate widely-used test protocols are in use in the NHS. Advice and information is available via our support for healthcare professionals.
IQoro is used by individuals across Europe to self-treat (75,000+ as of March 2022). It is used by healthcare professionals in the UK and in the Nordic countries.
Independent SLTs in the UK were early adopters, 30+ NHS Trusts deployed IQoro to some extent before prescription status, and the Drug Tariff listing from May 2022 will further increase these numbers.
A Service Evaluation conducted by the Royal Devon and Exeter NHS Trust and supported by the South West Academic Health Science Network (AHSN) specifically evaluated the suitability of IQoro in treating patients in NHS acute, in-patient rehab, and community settings.
IQoro is a cost-effective treatment
IQoro is listed on the Drug Tariff as a prescribable device. Part of the evaluation process for gaining this status was to provide proof of cost benefits over existing treatments. Possible savings are in the areas of:
- Avoided PEG insertion (£1,124)
- Reversed PEG insertion (PEG maintenance in the home costs £4,560 p.a.)
- Reduced drink thickener costs
- Reduced modified food costs
- Reduced hospital bed days where a recovered swallow can lead to an earlier discharge
Contradictions to the use of IQoro
IQoro is contraindicated in patients suffering from
- Trigeminal neuralgia
- Paraesophageal hernia
- Achalasia Cardiae
And the treatment should be started carefully for patients with
- Peripheral facial palsy