Oral trials in stroke and neurological rehabilitation
Results highlight that individuals on oral trials were more likely to have a neurological diagnosis and be on a neurological ward, supporting findings that oral trials are used within stroke rehabilitation6. One explanation for this may be that in the case of neurological damage, remaining nil by mouth in the early stages may limit the opportunities for recruitment and reorganisation of neurological pathways in contralateral brain regions17. Oral trials may therefore help to stimulate the neuromuscular system in the early stages of recovery. Oral trials support key principles of neuroplasticity in their approach, including ‘use it or lose it’, ‘use it and improve it’ and ‘specificity’12,18. Oral trials also utilise compensatory strategies with active rehabilitation to enable access to neural adaptation in the early stages of recovery 18.
Oral trials were also offered to patients on general medical, surgical, respiratory and intensive care wards, suggesting that the approach is not limited exclusively to neurological rehabilitation. One reason for dysphagia in these situations could be that reduced oral intake in critical care can cause muscle atrophy or deconditioning1,13,19,20. In these situations, oral trials may be used in active rehabilitation or at a ‘maintenance dose’ to reduce risk of deconditioning.