Advice
The technology
The technology
IQoro (MYOroface AB) is a neuromuscular training device and exercise regime used to relieve symptoms from stroke-related dysphagia by strengthening the muscles in the face, mouth, throat, oesophagus and diaphragm.
The device is made of acrylic and comprises a crescent-shaped panel that sits between the teeth and lips and a handle for pulling. The panel, or screen, is gripped in front of the teeth between closed lips and teeth and the loop is pulled outwards with the hand. To exercise, the user presses their lips together and pulls forward strongly for 5 to 10 seconds, repeating the exercise 3 times with 3 seconds of rest between repetitions. Training should be done 3 times each day, preferably before meals. People who cannot grip the device between their lips can use a 'jaw grip' technique. This involves the user using their fingers to pinch their lips closed while pulling with the other hand. People who cannot use the jaw grip technique can be helped by a carer. The device can be washed using soap and water, with toothpaste or in the dishwasher. IQoro is available in 2 sizes (small for children and large for adults).
The product is marketed for use in people with dysphagia and in people with a hiatus hernia and reflux symptoms. This briefing focuses on IQoro delivering swallowing therapy for treating dysphagia after a stroke. NICE has also published a medtech innovation briefing on IQoro for hiatus hernia.
Innovations
Swallowing exercises are typically used for treating dysphagia. The company claims exercises can be more accurately and effectively done using IQoro. No similar technologies are currently recommended in existing care guidelines.
Current NHS pathway or current care pathway
NICE's guideline on stroke rehabilitation in adults recommends offering swallowing therapy at least 3 times a week to people with dysphagia, after stroke, who are able to take part, for as long as they continue to make functional gains. Swallowing therapy could include compensatory strategies, exercises and postural advice.
The Royal College of Physicians National clinical guideline for stroke states that a number of treatments for dysphagia after stroke have been studied, including swallowing exercises, acupuncture, drugs, neuromuscular electrical stimulation, pharyngeal stimulation, thermal stimulation, and transcranial direct current or magnetic stimulation, but evidence on these is limited. Enteral tube feeding intervention can also be used, especially for people who may be at risk of aspiration. The guideline notes that outcomes of treatment should focus on freedom from tube feeding, quality of life and the duration of treatment effect.
IQoro would be used as well as standard treatment for stroke-related dysphagia, such as swallowing therapy.
Population, setting and intended user
IQoro is intended for use in the treatment of dysphagia, facial paralysis and other related conditions including speech difficulties, especially after stroke.
The device may be used in a hospital, community, or home setting. In most cases, the exercise is done by the patient after initial training by a healthcare professional. A carer can help if the patient lacks upper limb mobility or dexterity. The carer does not need to be a healthcare professional. The device does not need modification before use.
Costs
Technology costs
The cost of a single IQoro device is £116 (excluding VAT). The cost per unit is lower if the devices are ordered in bulk. There are no consumables or licence fees.
Costs of standard care
The standard alternative treatment for dysphagia is speech and language therapy to learn new swallowing techniques. NICE's guideline on stroke rehabilitation in adults recommends swallowing therapy at least 3 times a week. If a band 6 speech and language therapist provides a 30-minute session (£43 per working hour), it would cost about £65 per week.
While 20% of patients after a stroke may need enteral tube feeding during the acute phase, 8% will need long-term enteral tube feeding for more than 6 months. The cost of enteral tube feeding in the home setting is about £95 per week.
Resource consequences
According to the company there are currently around 10,000 users of the device in total, and around 500 of these are in the UK. Many UK users are private individuals. The company states that 15% of this population use IQoro to treat dysphagia.
No published evidence was found on the resource consequences of adopting the technology.
Device costs may be offset if less time is needed for swallowing therapy with a speech and language therapist or the need for enteral tube feeding is reduced.
No practical difficulties or changes in facilities and infrastructure are associated with adopting the technology.