Sweet success in swallowing: lollipop-based oral sensory-motor stimulation for dysphagia rehabilitation in tracheostomized patients with cognitive deficits - a case series

Abstract Introduction Dysphagia is highly prevalent in tracheostomized patients, particularly those with concomitant cognitive deficits due to brain injuries. Conventional swallowing rehabilitation often requires patient cooperation and comprehension, limiting its feasibility in this population. This case series explores the novel, simple and low-cost therapeutic use of lollipop sucking as an oral motor and sensory stimulation tool to improve swallowing function in this challenging patient population. Methods Five tracheostomized patients with clinically evident dysphagia and neurological/cognitive impairment following severe neurological (including diffuse axonal injury, subdural hemorrhage and subarachnoid hemorrhage) or cervical spine injury were included. The term cognitive impairment was used clinically to describe impaired neurological function and limited ability to participate consistently in conventional swallowing rehabilitation and no formal neuropsychological assessment was performed. These patients were administered a supervised lollipop-sucking regimen between January 2025 to December 2025. Patients were instructed to suck on flavored lollipops for 10–15 min, three times per day. Swallowing improvement was assessed clinically based on increased visible dietary intake, comfortable feeding and subsequent weight gain, enabling successful transition from nasogastric tube or percutaneous endoscopic gastrostomy feeding to oral feeds. Results The time to documented progression to adequate oral intake ranged from 5 days to 2 weeks among the five patients. Clinical improvement was observed within the first week in all cases, while the time to documented adequate oral intake ranged from 5 days to 2 weeks in Cases 1, 2, 3 and 5; Case 4 demonstrated significant swallowing improvement by day 7 but progressed to full oral intake over the subsequent months. Patients demonstrated improved oral intake, reduced coughing during feeding and progressive weight stabilization. No adverse events or choking episodes were observed during the intervention period. These observations suggest that the intervention was feasible and well tolerated in this small case series; however, its independent contribution to swallowing recovery cannot be determined. Conclusion In this small case series, supervised lollipop sucking was feasible and well tolerated as an adjunct to swallowing rehabilitation in patients with neurological or traumatic injury and dysphagia. The observed progression toward oral feeding is encouraging but cannot establish a causal treatment effect, particularly in the absence of a comparator group and objective instrumental swallowing assessment. Prospective controlled studies incorporating standardized clinical and instrumental outcome measures are required to determine its therapeutic efficacy and swallowing safety.