Perceptual and Motor Skills, 1991, 73, 441-442.
O Perceptual and Motor Skills 1991
PROGNOSTIC INDICATORS FOR SUCCESSFUL USE OF "TALKING" TRACHEOSTOMY TUBES ' STEVEN B. LEDER
Yale University School of Medicine Summary.-7 prognostic indicators for successful verbal communication for 40 patients who use "talking" tracheostomy tubes and who are cognitively intact and ventilator dependent are presented.
The primary goal of a talking tracheostomy tube is to allow cognitively intact, ventilator-dependent patients to communicate verbally. Communication is critical to patients' over-all medical care, psychological functioning, and social interactions (Safar & Grenvik, 1975; Levine, Koester, & Kett, 1987). When communication breaks down between the patient and health care professionals, the patient's abihty to participate in a meaningful way in the health care plan is greatly restricted (Parker, 1984; Sparker, Robbins, Nevlud, Watkins, & Jahrsdoerfer, 1987). Talking tracheostomy tubes, therefore, provide a vital component in the optimum care of the cognitively intact, ventilator-dependent, tracheostomized patient (Leder, 1990). A talking tracheostomy tube is a single cuffed tube designed with an external airflow line. Gas travels through the airflow line, exits via an opening just superior to the cuff, and then continues up through the glottis and vocal tract to allow speech production. Talking tracheostomy tubes have been successful in producing intelligible verbal communication for patients with spinal cord trauma, neuromuscular diseases, and respiratory failure (Safar & Grenvik, 1975; Levine, et al., 1787; Sparker, etal., 1987). The patient must be cognitively intact and ventilator-dependent for selection as a candidate for a talking tracheostomy tube, and the primary criteria for success or failure of the tube is adequate voice intensity for audible and intelligible speech production (Leder & Traquina, 1989; Leder, 1990). The prognostic indicators for patients' successful use of talking tracheostomy tubes have not been delineated. Subjects were 40 cognitively intact, ventilator-dependent, tracheostornized patients who had a talking tracheostomy tube. AU patients were seen daily by the speech-language with the goal of achieving verbal communication. I t was observed that the following indicators exhibited prognostic value towards successful verbal communication with a talking tracheostomy tube: Send re uests for re tints to Steven B. Lder, Ph.D., Yale University School of Medicine, Section o? 0tolaryngoP&y. Comrnvnication Disorders. 20 York Street, YPB 4 FI., New Haven, CT 06504.
442
S. B. LEDER
(1) Medical status is important. The patient should be able to participate actively in rehabilitation by being physically able to adduct the vocal folds in order to permit vibration and sound generation. If the patient is too weak to adduct the vocal folds, the patient will only be able to produce a whisper which may not be intelligible. (2) Daily rehabilitation by the speech-language pathologist is necessary to teach and reinforce proper use of a talking tracheostomy tube; cf. Leder and Traquina (1989) and Leder (1990) for specific techniques. (3) The appropriate airflow rate through the glottis should be established on an individual basis to allow adequate vocal intensity and speech intelligibility with minimal discomfort for the patient, i.e., usually 8 to 10 l/rnin., but can be as low as 2 or 3 l/min. and as high as 12 to 15 l/min. (4) Oral motor skills need to be within normal limits to permit normal articulation skills. (5) There is an absence of laryngeal pathology, e.g., vocal fold paralysis (Leder & Traquina, 1989), to allow vocal fold adduction and vibration for adequate voice intensity. (6) The patient is appropriately motivated to allow participation in rehabilitation, practice, and use of the taking tracheostomy tube during the day for verbal communication. (7) Staff and family support and encouragement ate provided to the patient to increase use of and successful verbal communication with the talking tracheostomy tube. REFERENCES
LEDER,S. B. (1990) Verbal communication for the ventilator dependent patient: voice intensity with the Portex "Talk" tracheostorny tube. Laryngoscope, 100, 1116-1121. LEDER, S. B., & TRAQUINA, D. T. (1989) Voice intensity of patients using a Communitrach I cuffed speaking tracheostomy tube. Laryngoscope, 99, 744-747. LEVINE, S. P.,KOESTER,D. J., & KETT, R. L. (1987) Independently activated talking tracheostorny systems for quadriplegic patients. Archives of Physical Medicine and Rehabilitation, 68, 571-573. PARKER,H. (1984) Communication breakdown: personal experience of being on ventilation. Nurse Mirror, 158, 37-39. SAFAR,l?, & GRENVLK, A. (1975) Speaking cuffed tracheostomy tube. Critical Care Medicine, 3, 23-26. SPARKER,A. W., ROBBINS,K. T., NEVLUD,G. N., WATKINS,C. N., & JAHRSDOERFER, R. A . (1987) A prospective evaluation of speaking tracheostomy tubes for ventilator dependent patients. Laryngoscope, 97, 89-92.
Accepted August 2 8, 199 1.
O Perceptual and Motor Skills 1991
PROGNOSTIC INDICATORS FOR SUCCESSFUL USE OF "TALKING" TRACHEOSTOMY TUBES ' STEVEN B. LEDER
Yale University School of Medicine Summary.-7 prognostic indicators for successful verbal communication for 40 patients who use "talking" tracheostomy tubes and who are cognitively intact and ventilator dependent are presented.
The primary goal of a talking tracheostomy tube is to allow cognitively intact, ventilator-dependent patients to communicate verbally. Communication is critical to patients' over-all medical care, psychological functioning, and social interactions (Safar & Grenvik, 1975; Levine, Koester, & Kett, 1987). When communication breaks down between the patient and health care professionals, the patient's abihty to participate in a meaningful way in the health care plan is greatly restricted (Parker, 1984; Sparker, Robbins, Nevlud, Watkins, & Jahrsdoerfer, 1987). Talking tracheostomy tubes, therefore, provide a vital component in the optimum care of the cognitively intact, ventilator-dependent, tracheostomized patient (Leder, 1990). A talking tracheostomy tube is a single cuffed tube designed with an external airflow line. Gas travels through the airflow line, exits via an opening just superior to the cuff, and then continues up through the glottis and vocal tract to allow speech production. Talking tracheostomy tubes have been successful in producing intelligible verbal communication for patients with spinal cord trauma, neuromuscular diseases, and respiratory failure (Safar & Grenvik, 1975; Levine, et al., 1787; Sparker, etal., 1987). The patient must be cognitively intact and ventilator-dependent for selection as a candidate for a talking tracheostomy tube, and the primary criteria for success or failure of the tube is adequate voice intensity for audible and intelligible speech production (Leder & Traquina, 1989; Leder, 1990). The prognostic indicators for patients' successful use of talking tracheostomy tubes have not been delineated. Subjects were 40 cognitively intact, ventilator-dependent, tracheostornized patients who had a talking tracheostomy tube. AU patients were seen daily by the speech-language with the goal of achieving verbal communication. I t was observed that the following indicators exhibited prognostic value towards successful verbal communication with a talking tracheostomy tube: Send re uests for re tints to Steven B. Lder, Ph.D., Yale University School of Medicine, Section o? 0tolaryngoP&y. Comrnvnication Disorders. 20 York Street, YPB 4 FI., New Haven, CT 06504.
442
S. B. LEDER
(1) Medical status is important. The patient should be able to participate actively in rehabilitation by being physically able to adduct the vocal folds in order to permit vibration and sound generation. If the patient is too weak to adduct the vocal folds, the patient will only be able to produce a whisper which may not be intelligible. (2) Daily rehabilitation by the speech-language pathologist is necessary to teach and reinforce proper use of a talking tracheostomy tube; cf. Leder and Traquina (1989) and Leder (1990) for specific techniques. (3) The appropriate airflow rate through the glottis should be established on an individual basis to allow adequate vocal intensity and speech intelligibility with minimal discomfort for the patient, i.e., usually 8 to 10 l/rnin., but can be as low as 2 or 3 l/min. and as high as 12 to 15 l/min. (4) Oral motor skills need to be within normal limits to permit normal articulation skills. (5) There is an absence of laryngeal pathology, e.g., vocal fold paralysis (Leder & Traquina, 1989), to allow vocal fold adduction and vibration for adequate voice intensity. (6) The patient is appropriately motivated to allow participation in rehabilitation, practice, and use of the taking tracheostomy tube during the day for verbal communication. (7) Staff and family support and encouragement ate provided to the patient to increase use of and successful verbal communication with the talking tracheostomy tube. REFERENCES
LEDER,S. B. (1990) Verbal communication for the ventilator dependent patient: voice intensity with the Portex "Talk" tracheostorny tube. Laryngoscope, 100, 1116-1121. LEDER, S. B., & TRAQUINA, D. T. (1989) Voice intensity of patients using a Communitrach I cuffed speaking tracheostomy tube. Laryngoscope, 99, 744-747. LEVINE, S. P.,KOESTER,D. J., & KETT, R. L. (1987) Independently activated talking tracheostorny systems for quadriplegic patients. Archives of Physical Medicine and Rehabilitation, 68, 571-573. PARKER,H. (1984) Communication breakdown: personal experience of being on ventilation. Nurse Mirror, 158, 37-39. SAFAR,l?, & GRENVLK, A. (1975) Speaking cuffed tracheostomy tube. Critical Care Medicine, 3, 23-26. SPARKER,A. W., ROBBINS,K. T., NEVLUD,G. N., WATKINS,C. N., & JAHRSDOERFER, R. A . (1987) A prospective evaluation of speaking tracheostomy tubes for ventilator dependent patients. Laryngoscope, 97, 89-92.
Accepted August 2 8, 199 1.
