Perspectives on Voice and Voice Disorders

Coordinator's Column

Sandage, M. — 2008-07-22

Dollars $$ Sense

Nikjeh, D. A. — 2008-07-22

Management of Adults With Tracheostomy Across the Continuum of Care

Tippett, D. C. — 2008-07-22

In this article, intervention for adults with tracheostomy and ventilator dependency specific to acute inpatient, rehabilitation, and outpatient settings is described. During the acute hospitalization, restoration of communication is paramount. Candidacy for different communication options is explored. Patients and families are introduced to the role of the speech-language pathologist and begin to become informed about tracheostomy. Education is provided about the effects of tracheostomy on speaking, prognosis for improvement of speech, and the need for post acute therapy. The emphasis of speech-language pathology intervention in the post acute setting, particularly in the rehabilitation setting, is maximizing independence. Specific goals include restoring oral communication during all waking hours; refining ventilator-supported speech production; facilitating independence with cuff deflation/inflation; and fostering autonomous application and care of speaking valves. The goals of outpatient intervention are to promote carryover, monitor, and re-evaluate clinical status as needed and foster return to school and employment, resumption of recreational activities, and reintegration into home and family.

Managing Voice and Communication for Tracheostomized and Ventilator Dependent Patients: Clinical Case Studies

Dikeman, K. J., Kazandjian, M. S. — 2008-07-22

This tutorial provides a background to the history of tracheostomy and ventilator-dependence, as well as two clinical case studies that describe the management of voice and communication. The rationale for establishment of upper airway flow in the tracheostomized and ventilator-dependent patient is explained. Assessment and treatment paradigms are described for the clinician working with this complex population, in order to provide guidelines for daily clinical practice.

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

Hofmann, L., Bolton, J., Ferry, S. — 2008-07-22

At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

Percutaneous Tracheostomy: A Multidisciplinary Approach

Pandian, V., Nguyen, T. T., Mirski, M., Bhatti, N. I. — 2008-07-22

The techniques of performing a tracheostomy has transformed over time. Percutaneous tracheostomy is gaining popularity over open tracheostomy given its advantages and as a result the number of bedside tracheostomies has increased necessitating the need for a Percutaneous Tracheostomy Program. The Percutaneous Tracheostomy Program at the Johns Hopkins Hospital is a comprehensive service that provides care to patients before, during, and after a tracheostomy with a multidisciplinary approach aimed at decreasing complications. Education is provided to patients, families, and health-care professionals who are involved in the management of a tracheostomy. Ongoing prospective data collection serves as a tool for Quality Assurance.