Assistive Drinking Devices: From Recommendation to Reality
Will the Liquid Intake Plan Work in Everyday Life?

‍Key Clinical Takeaways‍

• Successful dysphagia management depends not only on the swallowing plan itself, but on whether patients can realistically implement it throughout the day.
• Selecting an assistive drinking device requires consideration of swallowing physiology, motor function, cognition, posture, fatigue, caregiver support, and long-term usability.
• Adaptive drinking systems should be evaluated using a structured clinical reasoning framework rather than selected solely on product features.
• Clinicians should establish measurable outcomes when trialing assistive drinking devices, including hydration, efficiency, independence, and user acceptance.
• The RoseCup® System represents one configurable adaptive intake system that may help support individualized dysphagia management when integrated into comprehensive clinical care.
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Every Speech-Language Pathologist has experienced the same clinical scenario. A comprehensive swallowing assessment is completed, an individualized liquid intake plan is developed, and the patient demonstrates success during therapy. Yet several weeks later, hydration remains inadequate, the recommended drinking strategy has been abandoned, or caregivers report that the individual simply refuses to use the prescribed cup.

The clinical question is no longer whether the swallowing recommendations were appropriate. The more important question becomes: Will the liquid intake plan actually work in everyday life?

As dysphagia management evolves beyond aspiration prevention toward person-centered models of care, clinicians are increasingly challenged to bridge the gap between evidence-based recommendations and successful implementation. While significant progress has been made in swallowing assessment, rehabilitation, and standardization through the International Dysphagia Diet Standardisation Initiative (IDDSI), comparatively little attention has focused on systematically evaluating assistive drinking devices.

This gap deserves greater attention.

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) reminds clinicians that meaningful outcomes extend beyond impairment reduction to include activity, participation, environmental factors, and quality of life. In dysphagia management, this means asking not only whether a person can swallow safely during an evaluation, but whether they can maintain hydration safely, comfortably, and consistently throughout everyday life.
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A Clinical Reasoning Framework

Rather than beginning with a particular product, clinicians may find it helpful to begin with five practical questions that encourage analytical thinking about the interaction between swallowing physiology, functional ability, environmental demands, and device selection.
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1. Can the person physically manage the drinking vessel?

Successful drinking begins long before the swallow.

Upper extremity weakness, tremor, bradykinesia, impaired coordination, arthritis, fatigue, sensory loss, and reduced grip strength may all influence whether an individual can safely manipulate a drinking vessel. These impairments are common across neurological conditions including Parkinson's disease, stroke, multiple sclerosis, ALS, and dementia. Occupational Therapists are critical members of the interdisciplinary team to evaluate function and lend recommendations to adaptations for the eating and drinking ADLs. 

Consider:

• Grip strength
• Fine motor coordination
• Tremor
• Fatigue
• Independent versus caregiver-assisted drinking
• One-handed use
• Stability during transport
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The drinking vessel should complement the individual's functional abilities rather than introduce additional barriers to hydration. 
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2. Can the recommended posture be maintained?

Many swallowing recommendations depend upon maintaining appropriate head, neck, and trunk alignment.

If a drinking vessel requires excessive cervical extension or awkward positioning to access fluid, clinicians should consider whether the device supports or compromises prescribed swallowing strategies.

Questions to consider include:

• Does the cup require excessive head tilt?
• Can it be used comfortably while sitting or reclined?
• Does it support the posture recommended during instrumental assessment?
• Can caregivers assist without disrupting positioning?
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Supporting recommended posture may help optimize implementation of individualized swallowing recommendations.
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3. Can flow and bolus volume be individualized?

Fluid consistency represents only one component of safe drinking. Clinicians should also evaluate how the drinking device influences bolus delivery, flow regulation, pacing, and the individual's ability to initiate each swallow.

Important considerations include:

• IDDSI liquid level
• Flow characteristics
• Bolus size
• Drinking attachment
• Individual pacing
• Oral motor control
• Fatigue over repeated swallows
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Different neurological conditions often require different approaches. A person living with Parkinson's disease may require consideration of tremor, bradykinesia, and reduced oral efficiency. A stroke survivor may present with unilateral weakness or impaired coordination. An individual living with ALS may require progressive adaptation as motor abilities change over time.
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Beyond Physiology: Will the Person Continue Using It?

Even the most carefully selected device provides little benefit if it is abandoned after several days. Long-term adherence is influenced by practical considerations that extend beyond swallowing physiology, including:

• Appearance
• Comfort
• Beverage preference
• Temperature compatibility
• Ease of cleaning
• Portability
• Caregiver workflow
• Ease of assembly
• User confidence
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These human factors often determine whether clinical recommendations become sustainable daily habits.
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Measuring Success

Clinicians should establish objective outcome measures whenever introducing an assistive drinking device. Examples include:

• Daily fluid intake
• Drinking time
• Frequency of coughing or throat clearing
• Spillage
• Level of caregiver assistance
• Fatigue
• User satisfaction
• Caregiver burden
• Participation during meals
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Measuring functional outcomes allows clinicians to determine whether the intervention is supporting meaningful improvements in everyday life rather than relying solely on subjective impressions.
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Applying the Framework to the RoseCup® System

The RoseCup® System represents one configurable adaptive intake system that clinicians may consider within this clinical reasoning framework.

Importantly, adaptive drinking systems should always complement comprehensive swallowing assessment and individualized clinical management. Device selection should remain guided by clinical judgment, instrumental findings, person-centered goals, and ongoing reassessment.

The RoseCup® System is registered as a Class I Medical Device with the Australian Therapeutic Goods Administration (TGA). Lifemere is also a preferred supplier for Australian Health and Aged Care (AHAC) and proudly served as a 2025 global sponsor of IDDSI, supporting worldwide implementation of standardized dysphagia management.
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Looking Ahead

The evidence supporting assistive drinking technologies continues to evolve. A quality improvement study from Singapore demonstrated that introducing an adaptive drinking device within an acute care setting was associated with improvements in drinking independence and patient satisfaction while reducing caregiver workload. Although additional comparative research remains necessary, studies such as these highlight the growing importance of evaluating assistive technologies as part of comprehensive dysphagia management rather than viewing them simply as accessories.
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Conclusion

As assistive-device options continue to expand, clinicians will increasingly require practical frameworks for evaluating and selecting technologies that align with individualized goals of care. They do not need to become inventors, but they do need structured approaches to critical thinking that integrate swallowing physiology, functional ability, environmental demands, and long-term implementation.

Ultimately, successful dysphagia management is measured not only by safer swallowing during assessment, but by helping people maintain hydration, dignity, independence, and participation long after they leave the therapy room.
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References

International Dysphagia Diet Standardisation Initiative (IDDSI). https://iddsi.org

World Health Organization. International Classification of Functioning, Disability and Health (ICF). https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health

BMJ Open Quality. Improving patient hydration using an adaptive drinking device in acute care. https://bmjopenquality.bmj.com/content/11/4/e002055

Lifemere. The RoseCup® System. https://www.lifemere.com/education/the-rosecup-system‍

Jessica Ackerman, MS,CCC-SLP, is a Speech-Language Pathologist and dysphagia specialist with more than 25 years of experience in swallowing disorders, neurological rehabilitation, digital health, and healthcare innovation. As a clinical consultant to Lifemere, she is passionate about advancing person-centered dysphagia care through education, innovation, and practical solutions that support hydration, participation, independence, and quality of life.

Link to relevant articles:

• National Nursing Assistants Week: The Overlooked Frontline of Dysphagia Management, Hydration Monitoring, and Functional Swallowing Care
• Alzheimer's & Brain Awareness Month: Dysphagia, Hydration, and the Hidden Burden of Swallowing Dysfunction in Dementia Care
• ALS Global Awareness Day: Dysphagia, Hydration, and Preserving Quality of Life in Amyotrophic Lateral Sclerosis
• Bridging the Gap Between Clinical Recommendations and Everyday Drinking: Why the RoseCup® System Deserves a Place in Contemporary Dysphagia Management