4.5 Alaryngeal Speech Options Flashcards
What are the 4 major systems of speech?
- Power system –> lungs
- Phonatory system –> sound source (vocal folds)
- Shaping system –> resonance (pharyngeal, oral, and nasal cavities)
- Refinement system –> articulation
What changes occur in a laryngectomee patient? (2)
- Vibratory source (vocal folds) have been removed
- Power source (lungs) is disconnected from vibratory source
What is a pneumatic device?
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What are the advantages of a pneumatic devices? (7)
- Simple in design –> limited number of parts
- Durable
- Requires no batteries
- Hoarse voice rather than a mechanical sounding voice (buzzing) of electric devices
- Uses patient’s own air supply
- Inexpensive cost ($50.00 - 160.00)
- Models
How do pneumatic devices use patient’s own air supply? (2)
- Phonation is easily coordinated with respiration
- Normal phrasing and flow of speech are easy
What are the different models of Pneumatic devices? (3)
- Tone Airc II
- Tokyo Artificial Larynx
- Dutch Speech
What are the disadvantages of pneumatic devices? (6)
- Requires access to stoma
- Highly conspicuous –> visually distracting to the listener
- Requires one or two hands –> difficult to use if have a motor disorder
- Saliva will frequently clog the air tube
- No pitch control
- Very low fundamental frequency
What do we need to know about artificial larynx? (3)
- Source + Filter
- Placement varies
- Pros + Cons
What do we need to know about Intra oral devices? (4)
- All neck models can be fitted with an adapter that turns them into an oral device
- Embedded in denture/retainer
- Intra-Oral Adapter
- Hand held controller for on/off
What are the criteria that we use to choose an artificial larynx? (7)
- Preference
- Neck integrity
- Pulmonary status
- Manual dexterity
- Salivary situation
- Hearing aid
- Regularity of stoma
When should you conduct therapy with an artificial larynx?
as soon as possible; may preop introduce
How do you conduct therapy with clients who use an artificial larynx (AL)?
Group + individual (if possible) - 60-90 min sessions
What does therapy with an artificial larynx (AL) include? (5)
- Choose AL
- Work on placement and pressure
- Voicing
- Timing/phrasing
- Articulation
What are the steps of AL therapy?
5+4
- Demonstrate use & educate
- Palpate neck to find site
- Practice simple task while you push buttons (counting)
- Instruct patient to shape sounds with mouth + practice variations in sound. Make sure they don’t forcefully exhale
- When ready, patient starts to use device themselves + work on:
- —–Coordination with speech & button
- —–Natural pauses
- —–Reduced speech rate
- —–Increase articulation
What is the process of esophageal speech? (5)
A. Tongue press to inject air into esophagus
B. Air enters esophagus
C. Air released from esophagus to produce sound
D. Sound shaped into speech
E. Location of tissue vibration for sound
A normal air reservoir within the lungs of is approx. ____-____ ml of air. Approximately ____-____ ml of air are used in a typical phonation.
3500-4000
1500-2000
Esophagus can hold __-__ ml of air when fully inflated. However, it doesn’t fully inflate with injection of air. Only the top __ or __ inflates for voice production for speakers judged as ‘good’ and ‘superior’ esophageal speakers.
60-80
1/3 or 1/2
- PE segment may be damaged due to the what?
2. What must you have functioning?
- Original surgery
- PE segment
Pt’s with structural or nerve damage may not be able to use What?
Esophageal Speech
What are the therapy steps for esophageal speech? (5)
- Demonstrate the method & educate
- Help them feel comfortable with situation
- Try air injection (elicit burp), plosives (ta ta ta), last resort try swallowing
- Start with sound production-syllables-words-speech
- Slowing the rate of speech
- encouragement + education are huge with this approach!
What are the advantages of esophageal speech? (2)
- Don’t need anything
- Free
What are the disadvantages of esophageal speech? (2)
- Negative connotation
- Takes longer to learn
What are the different components of laryngeal speech in comparison to esophageal speech? (4)
- Power comes from moving air from the lungs
- Vibration source=vocal folds
- Resonator = vocal tract
- Articulators = tongue, teeth, lips, hard + soft palate
What are the different components of esophageal speech in comparison to laryngeal speech?(4)
- Power comes from injecting air into the esophagus + then moving air from the esophagus to the pharyngo-esophageal segment
- Vibration source=P-E segment
- Resonator = same
- Articulators = same
Where is the puncture for a tracheal esophageal puncture (TEP)?
- Puncture through pharyngoesophageal segment
How do you choose a candidate for TEP? (5)
- Good healing
- Free of disease, cognitive issues, + should be medically stable (eyesight, dexterity, good hygiene, etc.)
- Good stoma
- Emotionally stable
- Pass the insufflation testing
What are the advantages of TEP?
Quick restoration of voice, uses pulmonary air to drive speech, high success rate (85-95%)
What are the disadvantages of TEP? (2)
- Complications from surgery, stenosis, slight risk of aspiration, not all are candidates for this (very strict selection criteria used)
- TEP can be dislodged, defective, or person can develop a fistula. Usually see signs of discomfort such as coughing
